Meling Torstein R
Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Acta Neurochir Suppl. 2018;129:11-18. doi: 10.1007/978-3-319-73739-3_2.
Temporary parent vessel clip occlusion in aneurysm surgery is not always practical or feasible. Adenosine-induced transient cardiac arrest may serve as an alternative.
All patients who underwent microsurgical clipping of intracranial aneurysms under adenosine-induced asystole performed by the author between September 2011 and July 2014 were retrospectively reviewed.
A total of 16 craniotomies were performed and 16 aneurysms were clipped under adenosine-induced asystole (in 8 basilar arteries, 7 internal carotid arteries, and 1 middle cerebral artery) in 14 patients (8 females, 6 males). Seven cases were elective and 7 were performed after subarachnoid hemorrhage. The patients' mean age was 54 years (range, 39-70 years). The indications for adenosine use were proximal control in narrow surgical corridors in 11 cases, aneurysm softening in 4 cases, and aneurysm rupture in 1 case. A single dose was used in 12 patients; 2 patients had multiple boluses. The median (range) total dose was 30 (18-60) mg. Adenosine induced bradycardia with concomitant arterial hypotension in all patients and the majority also had asystole for 5-15 s. Transient cardiac arrhythmias were noted in 1 patient (atrial fibrillation in need of electroconversion after two boluses).
Nine clinical scenarios were identified in which adenosine-induced temporary cardiac arrest and deep hypotension was an effective adjunct to temporary clipping during the microsurgical clipping of intracranial aneurysms.
在动脉瘤手术中，临时夹闭供血母血管并非总是切实可行。腺苷诱导的短暂心脏停搏可能是一种替代方法。
回顾性分析2011年9月至2014年7月期间作者采用腺苷诱导心脏停搏进行颅内动脉瘤显微夹闭手术的所有患者。
14例患者（8例女性，6例男性）共进行了16次开颅手术，在腺苷诱导心脏停搏下夹闭了16个动脉瘤（8个位于基底动脉，7个位于颈内动脉，1个位于大脑中动脉）。7例为择期手术，7例在蛛网膜下腔出血后进行。患者平均年龄54岁（范围39 - 70岁）。使用腺苷的指征为：11例用于狭窄手术通道的近端控制，4例用于动脉瘤软化，1例用于动脉瘤破裂。12例患者使用单次剂量；2例患者多次推注。总剂量中位数（范围）为30（18 - 60）mg。所有患者腺苷均诱发心动过缓并伴有动脉低血压，大多数患者心脏停搏5 - 15秒。1例患者出现短暂心律失常（两次推注后发生房颤，需电复律）。
确定了9种临床情况，其中腺苷诱导的临时心脏停搏和深度低血压是颅内动脉瘤显微夹闭手术中临时夹闭的有效辅助手段。
