Adenosine for Temporary Flow Arrest During Intracranial Aneurysm Surgery: A Single-Center Retrospective Review

Bendok, Bernard R.; Gupta, Dhanesh K.; Rahme, Rudy J.; Eddleman, Christopher S.; Adel, Joseph G.; Sherma, Arun K.; Surdell, Daniel L.; Bebawy, John F.; Koht, Antoun; Batjer, H. Hunt

doi:10.1227/neu.0b013e318226632c

Cited by 85 publications

(81 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…247,248 The use of judicious temporary clipping of vessels to facilitate aneurysm dissection and clipping, or of adenosine for temporary cardiac arrest, especially in large aneurysms, offers additional techniques to enhance surgical safety. 249,250 Neuroprotection with intraoperative hypothermia has been assessed as a strategy to reduce the risk of surgical clipping. A pilot randomized study of intraoperative hypothermia demonstrated no outcome advantage in patients with UIAs.…”

Section: Other Considerations: Intraoperative Factors/ Technical Advamentioning

confidence: 99%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

794

352

View full text Add to dashboard Cite

Purpose— The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Methods— Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

show abstract

Section: Other Considerations: Intraoperative Factors/ Technical Advamentioning

confidence: 99%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

794

352

View full text Add to dashboard Cite

show abstract

“…74,[76][77][78][79] More recently, adenosine asystole has been introduced as an alternative to temporary clipping during the management of complex aneurysms. 81 Compared with the postoperative period, much less is known about the optimal preoperative and intraoperative management of anemia with red blood cell transfusions. Such transfusions generally constitute the minority of those given, 7,27,28 with only 3% of patients receiving them preoperatively 82 and 6% to 23% receiving them intraoperatively.…”

Section: Preoperative and Intraoperative Management Of Anemiamentioning

confidence: 99%

Anemia and Transfusion After Aneurysmal Subarachnoid Hemorrhage

Rosenberg

Koht

Naidech

2013

Journal of Neurosurgical Anesthesiology

Self Cite

View full text Add to dashboard Cite

Anemia is common in patients with aneurysmal subarachnoid hemorrhage (SAH), but these patients have constituted only a small fraction of those studied in large trials of anemia and transfusion. Unlike other critically ill patients, those with SAH face a well-defined risk of vasospasm and cerebral ischemia in the weeks after their hemorrhage. The risk of ongoing ischemia may make them less able to tolerate anemia and more likely to benefit from blood transfusion. The available data show that anemia is associated with poor outcomes after SAH but that blood transfusion does not consistently improve physiological markers, and it may be associated with poor outcomes. Most of these data are observational in nature, although 1 recent study demonstrated the safety and feasibility of maintaining relatively high transfusion thresholds in patients with SAH. Larger, randomized trials are needed to determine at what levels of anemia patients with SAH might benefit from transfusion, the optimal timing of transfusion, and how to identify those patients who are most likely to benefit.

show abstract

“…A retrospective data analysis from 2 centers in the United States showed that adenosine can be safely used to produce transient flow arrest without adverse cardiac or neurological outcome in patients with low risk for coronary artery disease. [179][180][181][182] A mean duration of 45 seconds of circulatory arrest can be achieved with 0.3 to 0.4 mg/kg of adenosine. 179 However, one should be prepared to manage prolonged asystolic arrest.…”

Section: Induced Hypotensionmentioning

confidence: 99%

Aneurysmal Subarachnoid Hemorrhage

2011

Encyclopedia of Clinical Neuropsychology

View full text Add to dashboard Cite

Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.Key Words: subarachnoid hemorrhage, intracranial aneurysm, delayed cerebral ischemia (J Neurosurg Anesthesiol 2015;27:222-240) SUBARACHNOID HEMORRHAGE (SAH) IS A WORLDWIDE HEALTH BURDEN WITH HIGH RATES OF FATALITY AND PERMANENT DISABILITYThe estimated worldwide incidence of SAH is 9/ 100,000 persons/y with regional variation. 1 One systematic review found the incidence to be lower in South and Central America (4.2/100,000 persons/y) and higher in Japan (22.7/100,000 persons/y) and Finland (19.7/100,000 persons/y). 1 Interestingly, the prevalence of intracranial aneurysm is not found to be higher in Japan or Finland, 2 but the risk for rupture is higher. 3 The incidence is also reported lower in China (2.0 //100,000 persons/y). 4 SAH accounts for only 5% of all strokes, 5 but it has high mortality and permanent disability rates. A retrospective cohort study in 2 large Norwegian populations between 1984 and 2007 reported a 30-day case fatality rate of 36%. 6 A nationwide Danish study reported a similar 30-day mortality at 38%. 7 World Health Organization Multinational Monitoring Trends...

show abstract

Adenosine for Temporary Flow Arrest During Intracranial Aneurysm Surgery: A Single-Center Retrospective Review

Abstract: Adenosine appears to allow safe flow arrest during intracranial aneurysm surgery. This can enhance the feasibility and safety of clipping in select circumstances.

Cited by 85 publications

References 39 publications

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Anemia and Transfusion After Aneurysmal Subarachnoid Hemorrhage

Aneurysmal Subarachnoid Hemorrhage

Contact Info

Product

Resources

About