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Adenosine-induced cardiac arrest during intraoperative cerebral aneurysm rupture.
MedLine Citation:
PMID:  19818474     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Rupture of an intracranial aneurysm during surgical clipping may have devastating consequences. Should this happen all methods ought to be considered to stop the bleeding. A short-term cardiac arrest induced by adenosine could be a feasible method to help the surgeon. We present our experiences in the administration of adenosine during an intraoperative aneurysm rupture. METHODS: Medical records of patients who underwent surgical clipping of a cerebral arterial aneurysm were reviewed from 2 university hospitals' operative database in the years 2003 to 2008. Patients were included in this study if adenosine had been administered during intraoperative rupture of an aneurysm. RESULTS: Altogether, 16 of 1014 patients were identified with the use of adenosine during an intraoperative rupture of an aneurysm. All of the patients had sinus rhythm and normotension before the rupture of the aneurysm. Twelve patients were administered a single dose of adenosine and 4 multiple boluses for induction of cardiac arrest; the median (range) total dose was 12 (6-18) mg and 27 (18-87) mg, respectively. The clipping of the aneurysm and the recovery of circulation were uneventful in all cases. In a subgroup analysis according to patient outcome as alive/dead, the pre- and postoperative neurologic condition correlated with the outcome, whereas adenosine did not have any effect on the patient outcome. CONCLUSION: In a case of a sudden aneurysm rupture, adenosine-induced circulatory arrest could be a safe option to facilitate clipping of an aneurysm. However, if adenosine is used, a very close collaboration between the surgeon and the anesthesiologist is required.
Authors:
Teemu Luostarinen; Riikka S K Takala; Tomi T Niemi; Ari J Katila; Mika Niemelä; Juha Hernesniemi; Tarja Randell
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2009-10-7
Journal Detail:
Title:  Surgical neurology     Volume:  -     ISSN:  1879-3339     ISO Abbreviation:  Surg Neurol     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Clinic, Helsinki University Central Hospital, Box, PO 266, FI-00029 Helsinki, Finland.
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