Transient cardiac standstill induced by adenosine in the management of intraoperative aneurysmal rupture: technical case report.
OBJECTIVE
Intraoperative aneurysmal rupture represents a potentially catastrophic event. We describe the use of an intravenous adenosine bolus to induce transient cardiac asystole to control a severe intraoperative aneurysmal rupture. This treatment resulted in a brief period of severe hypotension, which enabled successful clipping of the aneurysm.


METHODS
A 55-year-old man was referred to our institution 7 days after experiencing a mild subarachnoid hemorrhage from a fusiform, multilobulated aneurysm of the anterior communicating artery. The patient was found to have multiple additional fusiform aneurysms as well as a large parietal arteriovenous malformation.


METHODS
A craniotomy was performed to clip the aneurysm, but surgical dissection was complicated by premature rebleeding that could not be controlled satisfactorily with tamponade or temporary arterial occlusion. Infusion of adenosine resulted in the rapid onset of profound hypotension, allowing for safe completion of the dissection and clipping of the aneurysm with a good outcome. There were no complications identified in relation to the use of adenosine.


CONCLUSIONS
In the setting of severe intraoperative aneurysmal rupture, intravenous adenosine represents a potential means of achieving a near-immediate profound decrease in the blood pressure that may allow for safe completion of the dissection and aneurysm clipping.
Department of Neurological Surgery, University of Minnesota Hospital and Clinic, Minneapolis 55455, USA. nussb002@maroon.tc.umn.edu
E S
ES
Nussbaum
L A
LA
Sebring
I
I
Ostanny
W B
WB
Nelson
D000241:Adenosine / Q000627:therapeutic use*; D017542:Aneurysm, Ruptured / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000628:therapy*; D006801:Humans; D007022:Hypotension; D007431:Intraoperative Complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
D000241:Adenosine