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Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review.

Publication ,  Journal Article
Guinn, NR; McDonagh, DL; Borel, CO; Wright, DR; Zomorodi, AR; Powers, CJ; Warner, DS; Lam, AM; Britz, GW
Published in: J Neurosurg Anesthesiol
January 2011

UNLABELLED: 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.

Duke Scholars

Published In

J Neurosurg Anesthesiol

DOI

EISSN

1537-1921

Publication Date

January 2011

Volume

23

Issue

1

Start / End Page

35 / 40

Location

United States

Related Subject Headings

  • Vasospasm, Intracranial
  • Treatment Outcome
  • Retrospective Studies
  • Postoperative Complications
  • Patient Selection
  • Nicardipine
  • Neurosurgical Procedures
  • Middle Aged
  • Male
  • Length of Stay
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Guinn, N. R., McDonagh, D. L., Borel, C. O., Wright, D. R., Zomorodi, A. R., Powers, C. J., … Britz, G. W. (2011). Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review. J Neurosurg Anesthesiol, 23(1), 35–40. https://doi.org/10.1097/ANA.0b013e3181ef2b11
Guinn, Nicole R., David L. McDonagh, Cecil O. Borel, David R. Wright, Ali R. Zomorodi, Ciaran J. Powers, David S. Warner, Arthur M. Lam, and Gavin W. Britz. “Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review.J Neurosurg Anesthesiol 23, no. 1 (January 2011): 35–40. https://doi.org/10.1097/ANA.0b013e3181ef2b11.
Guinn NR, McDonagh DL, Borel CO, Wright DR, Zomorodi AR, Powers CJ, et al. Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review. J Neurosurg Anesthesiol. 2011 Jan;23(1):35–40.
Guinn, Nicole R., et al. “Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review.J Neurosurg Anesthesiol, vol. 23, no. 1, Jan. 2011, pp. 35–40. Pubmed, doi:10.1097/ANA.0b013e3181ef2b11.
Guinn NR, McDonagh DL, Borel CO, Wright DR, Zomorodi AR, Powers CJ, Warner DS, Lam AM, Britz GW. Adenosine-induced transient asystole for intracranial aneurysm surgery: a retrospective review. J Neurosurg Anesthesiol. 2011 Jan;23(1):35–40.

Published In

J Neurosurg Anesthesiol

DOI

EISSN

1537-1921

Publication Date

January 2011

Volume

23

Issue

1

Start / End Page

35 / 40

Location

United States

Related Subject Headings

  • Vasospasm, Intracranial
  • Treatment Outcome
  • Retrospective Studies
  • Postoperative Complications
  • Patient Selection
  • Nicardipine
  • Neurosurgical Procedures
  • Middle Aged
  • Male
  • Length of Stay