Adenosine-induced cardiac arrest during intraoperative cerebral aneurysm rupture

Luostarinen, Teemu; Takala, Riikka S.K.; Niemi, Tomi T.; Katila, Ari J.; Niemelä, Mika; Hernesniemi, Juha; Randell, Tarja

doi:10.1016/j.surneu.2009.06.018

« Previous Next »World Neurosurgery
Volume 73, Issue 2 , Pages 79-83, February 2010

Adenosine-induced cardiac arrest during intraoperative cerebral aneurysm rupture

Teemu Luostarinen, MD
- Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Clinic, Helsinki University Central Hospital, Box, PO 266, FI-00029 Helsinki, Finland
- Corresponding author.
Riikka S.K. Takala, MD, PhD
- Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Clinic, Turku University Hospital, Box, PO 52, FI-20521 Turku, Finland
Tomi T. Niemi, MD, PhD
- Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Clinic, Helsinki University Central Hospital, Box, PO 266, FI-00029 Helsinki, Finland
Ari J. Katila, MD
- Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Clinic, Turku University Hospital, Box, PO 52, FI-20521 Turku, Finland
Mika Niemelä, MD, PhD
- Department of Neurosurgery, Helsinki University Central Hospital, Box, PO 266, FI-00029 Helsinki, Finland
Juha Hernesniemi, MD
- Department of Neurosurgery, Helsinki University Central Hospital, Box, PO 266, FI-00029 Helsinki, Finland
Tarja Randell, MD, PhD
- Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Clinic, Helsinki University Central Hospital, Box, PO 266, FI-00029 Helsinki, Finland

Received 25 November 2008; accepted 17 June 2009. published online 12 October 2009.

Abstract

Background

Rupture of an intracranial aneurysm during surgical clipping may have devastating consequences. Should this happen all methods ought to be considered to stop the bleeding. A short-term cardiac arrest induced by adenosine could be a feasible method to help the surgeon. We present our experiences in the administration of adenosine during an intraoperative aneurysm rupture.

Methods

Medical records of patients who underwent surgical clipping of a cerebral arterial aneurysm were reviewed from 2 university hospitals' operative database in the years 2003 to 2008. Patients were included in this study if adenosine had been administered during intraoperative rupture of an aneurysm.

Results

Altogether, 16 of 1014 patients were identified with the use of adenosine during an intraoperative rupture of an aneurysm. All of the patients had sinus rhythm and normotension before the rupture of the aneurysm. Twelve patients were administered a single dose of adenosine and 4 multiple boluses for induction of cardiac arrest; the median (range) total dose was 12 (6-18) mg and 27 (18-87) mg, respectively. The clipping of the aneurysm and the recovery of circulation were uneventful in all cases. In a subgroup analysis according to patient outcome as alive/dead, the pre- and postoperative neurologic condition correlated with the outcome, whereas adenosine did not have any effect on the patient outcome.

Conclusion

In a case of a sudden aneurysm rupture, adenosine-induced circulatory arrest could be a safe option to facilitate clipping of an aneurysm. However, if adenosine is used, a very close collaboration between the surgeon and the anesthesiologist is required.

Abbreviations: ECG, electrocardiography, GCS, Glasgow Coma Scale, GOS, Glasgow Outcome Scale, SAH, subarachnoid hemorrhage

Keywords: Adenosine, Heart arrest, Intracranial aneurysm, Rupture, Spontaneous