Division of Neurosurgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Neurosurgery. 2010 Dec;67(2 Suppl Operative):461-70. doi: 10.1227/NEU.0b013e3181f7ef46.
Transient adenosine-induced asystole is a reliable method for producing a short period of relative hypotension during surgical and endovascular procedures. Although the technique has been described in the endovascular treatment of brain arteriovenous malformations, aortic aneurysms, and posterior circulation cerebral aneurysms, little description of its use in anterior circulation aneurysms is available.
To assess the benefits of adenosine-induced transient asystole in complex anterior circulation aneurysms, to describe our experience in selected cases, and to provide the first experience of the use of adenosine in anterior circulation aneurysms.
The adenosine-induced cardiac arrest protocol allows us to titrate the duration of cardiac arrest on the basis of individual patient responses. The operative setup is the same as with all aneurysm clippings, with the addition of the placement of transcutaneous pacemakers as a precaution for prolonged bradycardia or asystole. Escalating doses of adenosine are given to determine the approximate dose that results in 30 seconds of asystole. When requested by the surgeon, the dose of adenosine is administered for definitive dissection and clipping. We present 6 cases in which this technique was used.
The use of transient adenosine-induced asystole provided excellent circumferential visualization of the aneurysm neck and safe clip application. All patients did well neurologically and suffered no evidence of perioperative cerebral ischemia or delayed complication from the use of adenosine itself.
Transient adenosine-induced asystole is a safe and effective technique in select circumstances that may aid in safe and effective aneurysm clipping. Along with the traditional techniques of brain relaxation, skull base approaches, and temporary clipping, adenosine-induced asystole facilitates circumferential visualization of the aneurysm neck and is another technique available to cerebrovascular surgeons.
短暂的腺苷诱导的心动停止是一种在外科和血管内手术过程中产生相对低血压的可靠方法。尽管该技术已在脑动静脉畸形、主动脉瘤和后循环脑动脉瘤的血管内治疗中进行了描述，但很少有关于其在前循环动脉瘤中应用的描述。
评估腺苷诱导的短暂心动停止在复杂前循环动脉瘤中的益处，描述我们在选定病例中的经验，并提供腺苷在前循环动脉瘤中应用的首次经验。
腺苷诱导的心脏骤停方案允许我们根据患者个体的反应来滴定心脏骤停的持续时间。手术设置与所有动脉瘤夹闭相同，除了放置经皮起搏器作为预防长时间心动过缓和心动停止的措施。递增剂量的腺苷用于确定导致 30 秒心动停止的近似剂量。当外科医生要求时，给予腺苷剂量以进行明确的解剖和夹闭。我们提出了 6 例使用该技术的病例。
短暂的腺苷诱导的心动停止提供了极好的动脉瘤颈部的环形可视化和安全的夹闭应用。所有患者神经功能均良好，无围手术期脑缺血或腺苷本身使用引起的迟发性并发症的证据。
在某些情况下，短暂的腺苷诱导的心动停止是一种安全有效的技术，可能有助于安全有效地夹闭动脉瘤。与传统的脑松弛技术、颅底入路和临时夹闭技术一起，腺苷诱导的心动停止促进了动脉瘤颈部的环形可视化，是脑血管外科医生可用的另一种技术。
