Transient adenosine-induced asystole during the surgical treatment of anterior circulation cerebral aneurysms: technical note. uri icon

Overview

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. CONCLUSION: 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.

publication date

  • December 1, 2010

Research

keywords

  • Adenosine
  • Cardioplegic Solutions
  • Heart Arrest
  • Heart Arrest, Induced
  • Intracranial Aneurysm
  • Monitoring, Intraoperative
  • Neurosurgical Procedures

Identity

Scopus Document Identifier

  • 78650593730

Digital Object Identifier (DOI)

  • 10.1227/NEU.0b013e3181f7ef46

PubMed ID

  • 21099573

Additional Document Info

volume

  • 67

issue

  • 2 Suppl Operative