Adenosine-induced Transient Asystole for Intracranial Aneurysm Surgery

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

doi:10.1097/ana.0b013e3181ef2b11

Cited by 77 publications

(78 citation statements)

References 10 publications

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“…In selected patients with giant aneurysms, deep hypothermia with circulatory arrest under cardiopulmonary extracorporeal circulation has been shown to be a feasible and possibly useful technique, but outcome data are lacking. [192][193][194][195][196] Transient cardiac pause induced by adenosine has been used to control bleeding from intraoperative aneurysm rupture or to decompress large aneurysms and facilitate aneurysm clip application 197,198 ; however, controlled studies are needed to validate this intervention.…”

Section: Anesthetic Management During Surgical and Endovascular Treatmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,957

1,375

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Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). Methods— A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Results— Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. Conclusions— aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.

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Section: Anesthetic Management During Surgical and Endovascular Treatmentioning

confidence: 99%

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Connolly¹,

Rabinstein²,

Carhuapoma³

et al. 2012

Stroke

2,957

1,375

View full text Add to dashboard Cite

show abstract

“…No patient had any pulmonary side effects. The third case series, reported by Guinn et al, 15 included 27 patients whose aneurysms were primarily in the anterior circulation and whose surgeries where primarily elective. The individual adenosine dose range was 3 to 60 mg, and the total dose range was 3 to 285 mg.…”

Section: Adenosine-induced Transient Asystolementioning

confidence: 99%

“…In addition, adenosine can cause bronchoconstriction and therefore may be contraindicated for patients with asthma or chronic obstructive pulmonary disease. 14,15,[20][21][22][23] …”

Section: Disadvantages Complications and Contraindications Of Adenomentioning

confidence: 99%

“…Decompression of the aneurysm sac is often required for large aneurysms and can be accomplished with several techniques, including temporary parent vessel occlusion, intraoperative adenosine-induced transient asystole, 14,15 deep hypothermia with circulatory arrest, [16][17][18] and rapid ventricular pacing for flow arrest. 19 Temporary parent vessel occlusion can potentially injure the vessel and cause dissection or stroke from ischemia.…”

Section: Challenges Of Microsurgical Clippingmentioning

confidence: 99%

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Adenosine-Induced Transient Asystole

Britz

2014

Methodist DeBakey Cardiovascular Journal

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“…The authors concluded that the duration of hypotension, not necessarily asystole, was the single most important factor for adequate clip placement using this technique. 8 One serious complication during this study in one patient who experienced prolonged hypotension secondary to pulseless electrical activity required chemical intervention and cardiopulmonary resuscitation to reverse. The complication in this case was attributed to rapid redosing of adenosine without allowing for return of a normal hemodynamic profile between boluses.…”

Section: Adenosine-induced Cardiac Standstillmentioning

confidence: 99%

Cardiac standstill and circulatory flow arrest in surgical treatment of intracranial aneurysms: a historical review

Wright

Huang

Sharma

et al. 2014

FOC

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Since the first surgery for an intracranial aneurysm in 1931, neurological surgeons have long strived to determine the optimal methods of surgical correction. Significant challenges of aneurysm clipping include intraoperative rupture and complex dome morphology. Hypothermia, cardiopulmonary bypass, pharmacologically induced hypotension, and cardiac standstill are a few of the methodologies historically and currently employed in the management of these issues. In the 1980s, significant advances in pharmacology and anesthesiology led to the use of agents such as adenosine for chemically induced hypotension and eventually complete circulatory arrest. Since the institution of the use of these agents, the traditional methods of circulatory arrest under conditions of hypothermia and cardiopulmonary bypass have fallen out of favor. However, there still exists a subset of technically difficult aneurysms for which cardiac standstill, both chemical and hypothermic, remains a viable therapeutic option. In this paper, the authors describe the history of cardiac standstill by both hypothermic and chemically induced means as well as provide examples in which these techniques are still necessary.

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Adenosine-induced Transient Asystole for Intracranial Aneurysm Surgery

Abstract: 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.

Cited by 77 publications

References 10 publications

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

Adenosine-Induced Transient Asystole

Cardiac standstill and circulatory flow arrest in surgical treatment of intracranial aneurysms: a historical review

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