title: Perioperative cardiac complications and 30-day mortality in patients undergoing intracranial aneurysmal surgery with adenosine-induced flow arrest: a retrospective comparative study.
abstract: BACKGROUND
  Adenosine-induced flow arrest is a technique used to assist in the surgical clipping of complex aneurysms.
  
  
  OBJECTIVE
  To assess the safety associated with adenosine-assisted intracranial aneurysm surgery.
  
  
  METHODS
  Medical records of all patients presenting between January 1, 2009, and December 31, 2012, for intracranial aneurysm surgery were analyzed. Patients were divided into 2 groups based on the intraoperative administration of adenosine: the nonadenosine group (n = 262) and the adenosine group (n = 64). The primary outcome compared between groups included a composite of 30-day mortality and incidences of perioperative cardiac complications (perioperative myocardial infarction or perioperative cardiac arrhythmias).
  
  
  RESULTS
  The study groups were statistically similar except for a difference in the size and location of cerebral aneurysms and the incidence of coronary artery disease. The primary composite outcome occurred in 4.6% and 9.4% of patients in the nonadenosine and adenosine groups, respectively (P = .13). After adjustment for differences in the incidence of coronary artery disease between the 2 groups, the odds of the primary outcome were not significantly different between the groups (adjusted odds ratio = 2.12; 95% confidence interval, 0.76-5.93; P = .15). There were also no significant differences in the durations of hospital and intensive care unit stay between the study groups.
  
  
  CONCLUSIONS
  Our results suggest that adenosine-assisted intracranial aneurysm surgery is not associated with an increase in perioperative cardiac complications or mortality in patients with low risk of coronary artery disease and may be considered a safe technique to assist clipping of complex aneurysms.
authors.affiliation: *Department of Anesthesiology; §Departments of Surgery (Neurosurgery) and Radiology, and ¶Division of Neurocritical Care, Department of Neurology, Duke University Medical Center, Durham, North Carolina; ‡Department of Anesthesiology, Singapore General Hospital, Singapore; ‖Duke University Medical School, Durham, North Carolina; #Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas.
authors.forename: Shariq A
authors.initials: SA
authors.lastname: Khan
authors.forename: David L
authors.initials: DL
authors.lastname: McDonagh
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.forename: Sankalp
authors.initials: S
authors.lastname: Gokhale
authors.forename: Ulysses N
authors.initials: UN
authors.lastname: Toche
authors.forename: Terence
authors.initials: T
authors.lastname: Verla
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
authors.forename: Gavin W
authors.initials: GW
authors.lastname: Britz
mesh_terms: D000241:Adenosine / Q000009:adverse effects*; D000368:Aged; D000700:Analgesics / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000503:physiopathology*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D000241:Adenosine