Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review.
BRIEF SUMMARY: We describe the use of adenosine-induced cardiac arrest to facilitate intracranial aneurysm clip ligation.


BACKGROUND
Cerebral aneurysms are highly variable which may result in difficult surgical exposure for clip ligation in select cases. Secure clip placement is often not feasible without temporarily decompressing the aneurysm. This can be accomplished with temporary clip ligation of proximal vessels, or with deep hypothermic circulatory arrest on cardiopulmonary bypass, although these methods have their own inherent risks. Here we describe an alternate method of decompressing the aneurysm via adenosine-induced transient asystole.


METHODS
We examined the records of 27 patients who underwent craniotomy for cerebral aneurysm clipping in which adenosine was used to induce transient asystole to facilitate clip ligation. Duration of adenosine-induced bradycardia (heart rate <40) and hypotension (SBP < 60) recorded on the electronic anesthesia record and outcome data including incidence of successful clipping, intraoperative and postoperative complications, and mortality were recorded.


RESULTS
Satisfactory aneurysm decompression was achieved in all cases, and all aneurysms were clipped successfully. The median dose of intravenous adenosine resulting in bradycardia greater than 30 seconds was 30 mg. The median dose of adenosine resulting in hypotension greater than 30 seconds was 15 mg, and greater than 60 seconds was 30 mg. One case of prolonged hypotension after rapid redosing of adenosine required brief closed chest compressions before circulation was spontaneously restored. No other adverse events were observed.


CONCLUSIONS
Adenosine cardiac arrest is a relatively novel method for decompression of intracranial aneurysms to facilitate clip application. With appropriate safety precautions, it is a reasonable alternative method when temporary clipping of proximal vessels is not desirable or not possible.
Guinn
Nicole R
NR
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
McDonagh
David L
DL
Borel
Cecil O
CO
Wright
David R
DR
Zomorodi
Ali R
AR
Powers
Ciaran J
CJ
Warner
David S
DS
Lam
Arthur M
AM
Britz
Gavin W
GW
D000241:Adenosine / Q000008:administration & dosage / Q000009:adverse effects; D000368:Aged; D000768:Anesthesia, General; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D007430:Intraoperative Care; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009529:Nicardipine / Q000627:therapeutic use; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000209:etiology
D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D009529:Nicardipine; D000241:Adenosine