Grabert Josefin, Huber-Petersen Stefanie, Lampmann Tim, Eichhorn Lars, Vatter Hartmut, Coburn Mark, Velten Markus, Güresir Erdem
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, 53127 Bonn, Germany.
Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany.
J Clin Med. 2021 Nov 19;10(22):5406. doi: 10.3390/jcm10225406.
Surgical treatment of intracranial aneurysm requires advanced technologies to achieve optimal results. Recently, rapid ventricular pacing (RVP) has been described to be an elegant technique that facilitates clip reconstruction of complex unruptured intracranial aneurysm (uIA). However, there is also a growing need for intraoperative tools to ensure safe clip reconstruction of complex ruptured intracranial aneurysm (rIA). We conducted a retrospective analysis of 17 patients who underwent RVP during surgical reconstruction of complex aneurysms. Nine patients had uIA while eight patients underwent surgery for rIA suffering from consecutive subarachnoid hemorrhage (SAH). Hemodynamic data, critical events, laboratory results, and anesthesia-related complications were evaluated. No complications were reported concerning anesthesia induction and induction times were similar between patients exhibiting uIA or rIA ( = 0.08). RVP induced a significant decline of median arterial pressure (MAP) in both groups ( < 0.0001). However, median MAP before and after RVP was not different in both groups (uIA group: = 0.27; rIA group: = 0.18). Furthermore, high-sensitive Troponin T (hsTnT) levels were not increased after RVP in any group. One patient in the rIA group exhibited ventricular fibrillation and required cardiopulmonary resuscitation, but has presented with cardiac arrest due to SAH. Otherwise, no arrhythmias or complications occurred. In summary, our data suggest RVP to be feasible in surgery for ruptured intracranial aneurysms.
颅内动脉瘤的手术治疗需要先进技术以取得最佳效果。最近，快速心室起搏（RVP）已被描述为一种有助于复杂未破裂颅内动脉瘤（uIA）夹闭重建的精湛技术。然而，对于确保复杂破裂颅内动脉瘤（rIA）安全夹闭重建的术中工具的需求也日益增加。我们对17例在复杂动脉瘤手术重建期间接受RVP的患者进行了回顾性分析。9例患者患有uIA，而8例rIA患者因连续性蛛网膜下腔出血（SAH）接受手术。评估了血流动力学数据、关键事件、实验室结果及麻醉相关并发症。未报告与麻醉诱导有关的并发症，uIA或rIA患者的诱导时间相似（ = 0.08）。RVP使两组患者的平均动脉压（MAP）均显著下降（ < 0.0001）。然而，两组患者RVP前后的中位MAP无差异（uIA组： = 0.27；rIA组： = 0.18）。此外，任何组在RVP后高敏肌钙蛋白T（hsTnT）水平均未升高。rIA组有1例患者出现心室颤动，需要进行心肺复苏，但该患者因SAH出现心脏骤停。除此之外，未发生心律失常或并发症。总之，我们的数据表明RVP在破裂颅内动脉瘤手术中是可行的。
