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

Publication ,  Journal Article
Powers, CJ; Wright, DR; McDonagh, DL; Borel, CO; Zomorodi, AR; Britz, GW
Published in: Neurosurgery
December 2010

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.

Duke Scholars

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

December 2010

Volume

67

Issue

2 Suppl Operative

Start / End Page

461 / 470

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Monitoring, Intraoperative
  • Middle Aged
  • Male
  • Intracranial Aneurysm
  • Humans
  • Heart Arrest, Induced
  • Heart Arrest
 

Citation

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Powers, C. J., Wright, D. R., McDonagh, D. L., Borel, C. O., Zomorodi, A. R., & Britz, G. W. (2010). Transient adenosine-induced asystole during the surgical treatment of anterior circulation cerebral aneurysms: technical note. Neurosurgery, 67(2 Suppl Operative), 461–470. https://doi.org/10.1227/NEU.0b013e3181f7ef46
Powers, Ciaran J., David R. Wright, David L. McDonagh, Cecil O. Borel, Ali R. Zomorodi, and Gavin W. Britz. “Transient adenosine-induced asystole during the surgical treatment of anterior circulation cerebral aneurysms: technical note.Neurosurgery 67, no. 2 Suppl Operative (December 2010): 461–70. https://doi.org/10.1227/NEU.0b013e3181f7ef46.
Powers CJ, Wright DR, McDonagh DL, Borel CO, Zomorodi AR, Britz GW. Transient adenosine-induced asystole during the surgical treatment of anterior circulation cerebral aneurysms: technical note. Neurosurgery. 2010 Dec;67(2 Suppl Operative):461–70.
Powers, Ciaran J., et al. “Transient adenosine-induced asystole during the surgical treatment of anterior circulation cerebral aneurysms: technical note.Neurosurgery, vol. 67, no. 2 Suppl Operative, Dec. 2010, pp. 461–70. Pubmed, doi:10.1227/NEU.0b013e3181f7ef46.
Powers CJ, Wright DR, McDonagh DL, Borel CO, Zomorodi AR, Britz GW. Transient adenosine-induced asystole during the surgical treatment of anterior circulation cerebral aneurysms: technical note. Neurosurgery. 2010 Dec;67(2 Suppl Operative):461–470.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

December 2010

Volume

67

Issue

2 Suppl Operative

Start / End Page

461 / 470

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Neurosurgical Procedures
  • Neurology & Neurosurgery
  • Monitoring, Intraoperative
  • Middle Aged
  • Male
  • Intracranial Aneurysm
  • Humans
  • Heart Arrest, Induced
  • Heart Arrest