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Adenosine-induced Transient Asystole for Intracranial Aneurysm Surgery: A Retrospective Review

Guinn, Nicole R. MD*; McDonagh, David L. MD*; Borel, Cecil O. MD*; Wright, David R. MD*; Zomorodi, Ali R. MD; Powers, Ciaran J. MD, PhD; Warner, David S. MD*; Lam, Arthur M. MD§; Britz, Gavin W. MD

Journal of Neurosurgical Anesthesiology: January 2011 - Volume 23 - Issue 1 - p 35–40
doi: 10.1097/ANA.0b013e3181ef2b11
Clinical Report
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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.

*Department of Anesthesiology

Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, NC

Department of Neurosurgery, Ohio State University, Columbus, OH

§Swedish Neuroscience Institute, Seattle, WA

Reprints: David L. McDonagh, MD, Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710 (e-mail: david.mcdonagh@duke.edu).

Received April 29, 2010

Accepted June 28, 2010

© 2011 Lippincott Williams & Wilkins, Inc.