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

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

Research output: Contribution to journalReview article

45 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)35-40
Number of pages6
JournalJournal of Neurosurgical Anesthesiology
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2011

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Intracranial Aneurysm
Heart Arrest
Adenosine
Surgical Instruments
Aneurysm
Ligation
Hypotension
Bradycardia
Decompression
Deep Hypothermia Induced Circulatory Arrest
Induced Heart Arrest
Craniotomy
Intraoperative Complications
Cardiopulmonary Bypass
Thorax
Anesthesia
Heart Rate
Safety
Mortality
Incidence

Keywords

  • Adenosine arrest
  • Asystole
  • Cerebral aneurysm
  • Neuroanesthesia
  • Subarachnoid hemorrhage

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Surgery

Cite this

Adenosine-induced transient asystole for intracranial aneurysm surgery : A retrospective review. / Guinn, Nicole R.; McDonagh, David L.; Borel, Cecil O.; Wright, David R.; Zomorodi, Ali R.; Powers, Ciaran J.; Warner, David S.; Lam, Arthur M.; Britz, Gavin W.

In: Journal of Neurosurgical Anesthesiology, Vol. 23, No. 1, 01.01.2011, p. 35-40.

Research output: Contribution to journalReview article

Guinn, NR, McDonagh, DL, Borel, CO, Wright, DR, Zomorodi, AR, Powers, CJ, Warner, DS, Lam, AM & Britz, GW 2011, 'Adenosine-induced transient asystole for intracranial aneurysm surgery: A retrospective review', Journal of Neurosurgical Anesthesiology, vol. 23, no. 1, pp. 35-40. https://doi.org/10.1097/ANA.0b013e3181ef2b11
Guinn, Nicole R. ; McDonagh, David L. ; Borel, Cecil O. ; Wright, David R. ; Zomorodi, Ali R. ; Powers, Ciaran J. ; Warner, David S. ; Lam, Arthur M. ; Britz, Gavin W. / Adenosine-induced transient asystole for intracranial aneurysm surgery : A retrospective review. In: Journal of Neurosurgical Anesthesiology. 2011 ; Vol. 23, No. 1. pp. 35-40.
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AU - Guinn, Nicole R.

AU - McDonagh, David L.

AU - Borel, Cecil O.

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AU - Zomorodi, Ali R.

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AU - Warner, David S.

AU - Lam, Arthur M.

AU - Britz, Gavin W.

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N2 - 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.

AB - 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.

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KW - Asystole

KW - Cerebral aneurysm

KW - Neuroanesthesia

KW - Subarachnoid hemorrhage

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