title: Transient adenosine-induced asystole during the surgical treatment of anterior circulation cerebral aneurysms: technical note.
abstract: BACKGROUND
  Transient adenosine-induced asystole is a reliable method for producing a short period of relative hypotension during surgical and endovascular procedures. Although the technique has been described in the endovascular treatment of brain arteriovenous malformations, aortic aneurysms, and posterior circulation cerebral aneurysms, little description of its use in anterior circulation aneurysms is available.
  
  
  OBJECTIVE
  To assess the benefits of adenosine-induced transient asystole in complex anterior circulation aneurysms, to describe our experience in selected cases, and to provide the first experience of the use of adenosine in anterior circulation aneurysms.
  
  
  METHODS
  The adenosine-induced cardiac arrest protocol allows us to titrate the duration of cardiac arrest on the basis of individual patient responses. The operative setup is the same as with all aneurysm clippings, with the addition of the placement of transcutaneous pacemakers as a precaution for prolonged bradycardia or asystole. Escalating doses of adenosine are given to determine the approximate dose that results in 30 seconds of asystole. When requested by the surgeon, the dose of adenosine is administered for definitive dissection and clipping. We present 6 cases in which this technique was used.
  
  
  RESULTS
  The use of transient adenosine-induced asystole provided excellent circumferential visualization of the aneurysm neck and safe clip application. All patients did well neurologically and suffered no evidence of perioperative cerebral ischemia or delayed complication from the use of adenosine itself.
  
  
  CONCLUSIONS
  Transient adenosine-induced asystole is a safe and effective technique in select circumstances that may aid in safe and effective aneurysm clipping. Along with the traditional techniques of brain relaxation, skull base approaches, and temporary clipping, adenosine-induced asystole facilitates circumferential visualization of the aneurysm neck and is another technique available to cerebrovascular surgeons.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Ciaran J
authors.initials: CJ
authors.lastname: Powers
authors.forename: David R
authors.initials: DR
authors.lastname: Wright
authors.forename: David L
authors.initials: DL
authors.lastname: McDonagh
authors.forename: Cecil O
authors.initials: CO
authors.lastname: Borel
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz
mesh_terms: D000241:Adenosine / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D002314:Cardioplegic Solutions / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D002314:Cardioplegic Solutions; D000241:Adenosine