caa a22 4500 60621674X CHVBK 20210128101104.0 cr unu---uuuuu 210128e20151101xx s 000 0 eng 10.1007/s00701-015-2581-7 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2581-7 Adenosine-induced transient asystole during intracranial aneurysm surgery: indications, dosing, efficacy, and risks [Elektronische Daten] [Sung Lee, Byung Kwun, Joung Kim, Jeong-Hyun Choi, Jae Ahn, Wonhyoung Park, Jung-Ho Yun] Background: Several flow-arrest techniques have been introduced for the treatment of complex aneurysms that cannot be treated with conventional clipping or endovascular coil embolization. Adenosine-induced transient asystole is an alternative method of flow arrest. However, given the limited number of studies that have reported on this topic, there is no consensus regarding the dose, regimen, efficacy, and potential risks of adenosine. Method: A total of 22 aneurysms in 22 different patients that underwent adenosine-induced transient asystole during aneurismal neck clipping within the past 4years were retrospectively reviewed. Adenosine was administrated intravenously in a test-incremental manner (starting with 6-12 mg and then giving additional doses as needed) in 11 patients and in an estimated manner (pre-calculated as 0.3-0.4 mg/kg) in 11 patients. Results: Overall, the study consisted of 18 unruptured saccular aneurysms, three ruptured saccular aneurysms, and a ruptured pseudoaneurysm. Adenosine-induced transient asystole was used in cases of temporary clipping inability, wide necked aneurysm, deep-seated aneurysm, or a thin aneurysm wall. The number of administrations, dose (mg/kg in ideal body weight) and duration of asystole were 1-4 (mean, 2.3) times, 0.08-1.27 (mean, 0.36) mg/kg and 0-30 (mean 13) seconds in the test-incremental manner and 1-2 (mean, 1.09) times, 0.24-0.42 (mean, 0.34) mg/kg and 13-41 (mean, 24) seconds in the estimated manner, respectively. There was a linear relationship between the dose and the duration of asystole. Twenty out of 22 aneurysms were clipped successfully with adenosine-induced transient asystole. However, in the other two cases, additional suction decompression was required for the final clipping. Adenosine-related cardiologic complications occurred in two cases of self-limited atrial fibrillation during restoration of the cardiac rhythm. Conclusions: In our experience, adenosine-induced transient asystole was safe and helpful for satisfactory clipping of a complicated aneurysm. An estimated dose injection of adenosine was more convenient than the test-incremental method and did not result in serious cardiologic problems. Springer-Verlag Wien, 2015 Aneurysm nationallicence Adenosine nationallicence Surgery nationallicence Asystole nationallicence Brain nationallicence Complication nationallicence Lee Sung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736, Songpa-gu, Seoul, Korea aut Kwun Byung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736, Songpa-gu, Seoul, Korea aut Kim Joung Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea aut Choi Jeong-Hyun Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea aut Ahn Jae Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736, Songpa-gu, Seoul, Korea aut Park Wonhyoung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736, Songpa-gu, Seoul, Korea aut Yun Jung-Ho Department of Neurosurgery, College of Medicine, Dankook University, Cheonan, Korea aut Acta Neurochirurgica Springer Vienna 157/11(2015-11-01), 1879-1886 0001-6268 157:11<1879 2015 157 701 https://doi.org/10.1007/s00701-015-2581-7 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2581-7 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lee Sung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736, Songpa-gu, Seoul, Korea aut NATIONALLICENCE 700 1- Kwun Byung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736, Songpa-gu, Seoul, Korea aut NATIONALLICENCE 700 1- Kim Joung Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea aut NATIONALLICENCE 700 1- Choi Jeong-Hyun Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea aut NATIONALLICENCE 700 1- Ahn Jae Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736, Songpa-gu, Seoul, Korea aut NATIONALLICENCE 700 1- Park Wonhyoung Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, 138-736, Songpa-gu, Seoul, Korea aut NATIONALLICENCE 700 1- Yun Jung-Ho Department of Neurosurgery, College of Medicine, Dankook University, Cheonan, Korea aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/11(2015-11-01), 1879-1886 0001-6268 157:11<1879 2015 157 701