Perioperative Cardiac Complications and 30-Day Mortality in Patients Undergoing Intracranial Aneurysmal Surgery With Adenosine-Induced Flow Arrest

Khan, Shazia; McDonagh, David L.; Adogwa, Owoicho; Gokhale, Sankalp; Toche, Ulysses; Verla, Terence; Zomorodi, Ali R.; Britz, Gavin W.

doi:10.1227/neu.0000000000000258

Cited by 33 publications

(48 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The studies have shown that 57 (24.7%) of 231 patients got adenosine during posterior circulation clipping, which include 25(10.8%) basilar artery aneurysm and 29(12.55%) unsorted posterior circulation aneurysm. This supports the fact that the surgeries in this area are generally more difficult, with deep and narrow corridor; thus they are technically more challenging [3,9,11,18,19] .…”

Section: Indications Of Using Adenosine-induced Flow Arrest For Complsupporting

confidence: 60%

“…Of these 16 patients, 12 patients got 1 bolus, and 4 patients received multiple bolus. Median dose for a single injection was 12 mg (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), and the median total dose for multiple injections was 27 mg . Ten minutes after adenosine administration, all patients were hemodynamically stable, and 13 required vasoactive drugs during the procedure.…”

Section: Dose Of Adenosinementioning

confidence: 99%

See 1 more Smart Citation

Flow Arrest for Complex Intracranial Aneurysm Surgery by Using Adenosine

Wang

Yamada

Kawase

et al. 2018

Neurovascular Surgery

View full text Add to dashboard Cite

Section: Indications Of Using Adenosine-induced Flow Arrest For Complsupporting

confidence: 60%

Section: Dose Of Adenosinementioning

confidence: 99%

Flow Arrest for Complex Intracranial Aneurysm Surgery by Using Adenosine

Wang

Yamada

Kawase

et al. 2018

Neurovascular Surgery

View full text Add to dashboard Cite

“…The complication rate after RVP, which has to be weighed against the considerable risk of spontaneous rupture of the aneurysms treated in this series, appears to be comparable to or lower than that reported after administration of adenosine in retrospective studies (Table 4). 4,5,22 Adenosine is easy available and usable, but it is not predictable, if the cardiac arrest persists (up to 20% of the patients had no effect in a prospective trial 11 ) and depending on how long (most often 10-30 seconds); 3,5,18,25 with RVP the anesthesiologist has a device with on/off demand for a tailored induction of hypotension. Also, after adenosine application, hypotension persists longer (5-10 minutes) than after RVP, requiring vasoactive agents in some patients.…”

Section: Why Rvp and Not Adenosine?mentioning

confidence: 99%

Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trial

Konczalla¹,

Platz²,

Fichtlscherer

et al. 2018

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE To date, treatment of complex unruptured intracranial aneurysms (UIAs) remains challenging. Therefore, advanced techniques are required to achieve an optimal result in treating these patients safely. In this study, the safety and efficacy of rapid ventricular pacing (RVP) to facilitate microsurgical clip reconstruction was investigated prospectively in a joined neurosurgery, anesthesiology, and cardiology study. METHODS Patients with complex UIAs were prospectively enrolled. Both the safety and efficacy of RVP were evaluated by recording cardiovascular events and outcomes of patients as well as the amount of aneurysm occlusion after the surgical clip reconstruction procedure. A questionnaire was used to evaluate aneurysm preparation and clip application under RVP. RESULTS Twenty patients (mean age 51.6 years, range 28-66 years) were included in this study. Electrode positioning was easy in 19 (95%) of 20 patients, and removal of electrodes was easily accomplished in all patients (100%). No complications associated with the placement of the pacing electrodes occurred, such as cardiac perforation or cardiac tamponade. RVP was applied in 16 patients. The mean aneurysm size was 11.1 ± 5.5 mm (range 6-30 mm). RVP proved to be a very helpful tool in aneurysm preparation and clip application in 15 (94%) of 16 patients. RVP was used for a mean duration of 60 ± 25 seconds, a mean heart rate of 173 ± 23 bpm (range 150-210 bpm), and a reduction of mean arterial pressure to 35-55 mm Hg. RVP leads to softening of the aneurysm sac facilitating its mobilization, clip application, and closure of the clip blades. In 2 patients, cardiac events were documented that resolved without permanent sequelae in both. In every patient with successful RVP (n = 14) a total or near-total aneurysm occlusion was documented. In the 1 patient in whom the second RVP failed due to pacemaker electrode dislocation, additional temporary clipping was required to secure the aneurysm, but was not as sufficient as RVP. This led to an incomplete clipping of the aneurysm and finally a remnant on postoperative digital subtraction angiography. A pacemaker lead dislocation occurred in 3 (19%) of 16 patients, but intraoperative repositioning requires less than 20 seconds. Outcome was favorable in all patients according to the modified Rankin Scale. CONCLUSIONS To the best of the authors' knowledge this is the first prospective interdisciplinary study of RVP use in patients with UIAs. RVP is an elegant technique that facilitates clip reconstruction in complex UIAs. The safety of the procedure is good. However, because this procedure requires extensive preoperative cardiological workup of the patient and an experienced neurosurgery and neuroanesthesiology team with much cerebrovascular expertise, actually it remains reserved for selected elective cases and highly specialized centers. Clinical trial registration no.: NCT02766972 (clinicaltrials.gov).

show abstract

“…Недостаточно прогнозируемыми остаются длительность асистолии, а также невозможность безопасного обеспечения двух и более ее последовательных эпизодов. Кроме того, нельзя забывать о феномене коронарного обкрадывания и бронхоспастическом потенциале препарата, следовательно, снижение коронарного резерва и наличие в анамнезе хронической обструктивной болезни легких должны быть относительными противопоказаниями к применению данного метода [95]. Соответственно необходимо быть готовым к развитию аритмологических, респираторных осложнений, коррекции длительности периода асистолии, брадикардии, стойкой гипотензии.…”

Section: аденозин-индуцированный транзиторный кардиальный арестunclassified

Methods for prevention of intraoperative rupture during surgical interventions of intracranial aneurysm clipping

Kim

Шин

Vinokurov

et al. 2018

Journal of Clinical Practice

View full text Add to dashboard Cite

Intraoperative aneurysmal rupture (IAR) is one of the most dramatic complications of intracranial intervention. Its frequency, depending on the aneurysm’s localization and anatomical features, may reach 50%. IAR leads to the increase of unfavorable outcomes by 1.5–3 times. There exists a variety of techniques aimed to reduce the frequency of this complication, however, all of them have essential limitations. The review presents analyses of the basic risk factors for IAR and techniques of its prevention, as well as modern approaches directed at the alleviation of this complication’s consequences.

show abstract

Perioperative Cardiac Complications and 30-Day Mortality in Patients Undergoing Intracranial Aneurysmal Surgery With Adenosine-Induced Flow Arrest

Cited by 33 publications

References 16 publications

Flow Arrest for Complex Intracranial Aneurysm Surgery by Using Adenosine

Flow Arrest for Complex Intracranial Aneurysm Surgery by Using Adenosine

Rapid ventricular pacing for clip reconstruction of complex unruptured intracranial aneurysms: results of an interdisciplinary prospective trial

Methods for prevention of intraoperative rupture during surgical interventions of intracranial aneurysm clipping

Contact Info

Product

Resources

About