Abstract 2902: Usefulness Of Adenosine Induced Transient Cardiac Arrest For Aneurysm Decompression Without Temporary Clipping In Intracranial Aneurysm Clipping
Introduction: Temporary clipping of proximal vessel in intracranial aneurysm clipping can be used in a generalized procedure to reduce flow to the aneurysm, but this method has own disadvantages including postoperative ischemia or the possibility to obscure the surgeon’s view during clipping. On the other hand, adenosine induced transient cardiac arrest facilitated the safe clipping of the aneurysm by producing relaxation of the brain and the aneurysmal sac decompression without temporary clipping. Its action is characterized by a rapid onset, brief duration and rapid spontaneous reversal without associated complications.
Hypothesis: Aneurysm clipping with adenosine induced cardiac arrest is the safe and brief procedure without any cardio-pulmonary or neurologic complications.
Methods: We used a retrospectively collected 527 patients’ database which was treated by intracranial aneurysm clipping from January 2010 to June 2011 in our institution and selected 13 patients who had adenosine induced cardiac arrest during aneurysm clip application. Arrest time, arrest frequency, arrest achieving dose and recovery of cardiac arrest recorded on anesthesia record, and the report focuses on outcome data including aneurysm decompression, incidence of successful clipping, perioperative cardio-pulmonary or neurologic complications.
Results: All of the 13 patients had sinus rhythm and normotension before operation and had been confirmed as good function by cardio-pulmonary consultation and examination. Twelve patients had unruptured intracranial aneurysms and another one patient had a ruptured anterior communicating artery aneurysm. The mean of cardiac arrest achieved dose was 20 mg with ranging from 6 to 63 mg and the mean arrest time was 26 seconds with ranging from 4 to 90 seconds. Satisfactory aneurysm decompression was achieved in all 13 cases, and all aneurysms were clipped successfully without temporary clipping and wide neck dissection although we had two sudden ruptured cases during operation. Also, all patients had no perioperative complications including cardio-pulmonary problems and cerebral infarction within mean follow-up period 5 months (2∼12 months).
Conclusions: Adenosine induced transient cardiac arrest is a relatively unfamiliar method for aneurysmal sac decompression to facilitate clipping of an aneurysm. But, with preoperative sufficient evaluation of cardio-pulmonary system, accurate monitoring during operation time and intimate co-operation between the surgeon and the anesthesiologist, this method is an excellent procedure with good effectiveness and safe option to facilitate clipping of an aneurysm, especially the following 3 situations: 1) large sized aneurysms with nonvisulization of proximal vessel. 2) paraclinoid aneurysms with impossible proximal neck dissection. 3) sudden aneurysm rupture during operation.
- © 2012 by American Heart Association, Inc.