Transient ventricular asystole using adenosine during minimally invasive and open sternotomy coronary artery bypass grafting

Robinson, M. Clive; Thielmeier, Kenneth A.; Hill, Bruce C.

doi:10.1016/s0003-4975(97)00431-1

Cited by 38 publications

(11 citation statements)

References 11 publications

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“…The current application of adenosine has been expanding beyond its use as an antiarrhythmic agent. Adenosineinduced transient asystole has been used during minimally invasive coronary artery bypass grafting, 9 endovascular repair of aortic aneurysms, 4 and embolization of cerebral arteriovenous malformations. 8 The ultimate clinical utility of adenosine-induced asystole for aneurysm clipping remains to be defined.…”

Section: Discussionmentioning

confidence: 99%

Adenosine-induced transient asystole for management of a basilar artery aneurysm

Groff¹,

Adams²,

Kahn³

et al. 1999

Journal of Neurosurgery

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Advances in anesthetic and surgical management, such as induced deep hypothermic circulatory arrest and application of temporary clips, have improved outcome for patients with basilar artery aneurysms. Nonetheless, these techniques are associated with significant risks. The authors report a case in which three transient periods of cardiac asystole were induced during basilar artery aneurysm surgery. Adenosine-induced asystole facilitated the safe clipping of the aneurysm by producing consistent periods of profound hypotension and collapse of the aneurysm without the need for temporary clipping. This technique provided unencumbered identification of perforating arteries, precise definition of the local anatomy, and an ideal environment for the safe placement of the aneurysm clip.

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Section: Discussionmentioning

confidence: 99%

Adenosine-induced transient asystole for management of a basilar artery aneurysm

Groff¹,

Adams²,

Kahn³

et al. 1999

Journal of Neurosurgery

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“…The adverse events profile with ticagrelor is clearly inferior to that with clopidogrel. In contrast to all thienopyridines, classical examples of adenosine overload such as transitory bronchoconstriction causing dyspnoea, 12,13 arrhythmogenic hazards resulting in ventricular asystole or pauses, 14,15 and metabolically induced anxiety manifesting itself as agitation or panic attacks 16 -18 were commonly observed after ticagrelor. Impaired purine catabolism due to increased adenosine levels may cause elevated serum creatinine and uric acid, 19,20 more frequently observed with ticagrelor in PLATO.…”

Section: Adverse Eventsmentioning

confidence: 99%

“…29 Considering that the adenosine receptors A1, A2A, A2B, and A3 modulate oppositely directed physiological functions, their interplay and differential up-regulation may explain some of the proarrhythmic properties of ticagrelor early during drug administration, with prevention of ventricular tachyarrhythmias and sudden death late in the trial. Since in PLATO ticagrelor prevented more deaths than MIs, it may be worthwhile to focus future investigations on the prevention of fatal ventricular tachycardias and sudden death, 30 as well as other arrhythmias, 14,15,31 and heart failure benefit rather than thrombotic occlusions alone.…”

Section: Beyond Plateletsmentioning

confidence: 99%

The PLATO trial: do you believe in magic?

Serebruany

Atar

2009

European Heart Journal

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The PLATO trial revealed a remarkable advantage of ticagrelor over clopidogrel in ACS patients. Unless the regulatory authorities discover serious flaws with the study, which is unlikely, the drug may substantially change the present landscape of oral antiplatelet therapy, especially in high-risk patients. Despite a somewhat unfavourable safety profile, ticagrelor has a lot of room to compensate for these well-defined side effects based on a documented absolute mortality reduction, solid prevention of MI, and convincing pattern of benefit growing over time.

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“…Some centres have found that it may be beneficial to increase heart rate during grafting of the right coronary and circumflex arteries. Adenosine has been used to optimise the surgical field and to facilitate anastomotic accuracy by inducing controlled intervals of ventricular asystole, producing a transiently still cardiac field [35].…”

Section: Anaesthetic Techniquementioning

confidence: 99%

Off‐pump coronary artery surgery

Heames¹,

Gill²,

Ohri

et al. 2002

Anaesthesia

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Cardiopulmonary bypass has several associated deleterious effects that include a systemic inflammatory response, coagulopathy, central nervous system complications and a variable degree of end-organ damage. The recent upsurge in interest in "beating-heart" surgery attempts to avoid these deleterious effects. Advances in surgical technique, such as the use of intracoronary shunts and the Octopus retractor, have made beating-heart surgery a reality. The challenges for the anaesthetist are greater than for coronary artery surgery using cardiopulmonary bypass, and whilst some advantages are proven, such as the lack of the inflammatory response and the decreased need for blood or blood products, others have yet to be proved and there is a need for further research. The advantages and disadvantages need to be evaluated in randomised studies in order to confirm the safety and efficacy of these new techniques in terms of long-term graft patency and decreased morbidity.

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Transient ventricular asystole using adenosine during minimally invasive and open sternotomy coronary artery bypass grafting

Cited by 38 publications

References 11 publications

Adenosine-induced transient asystole for management of a basilar artery aneurysm

Adenosine-induced transient asystole for management of a basilar artery aneurysm

The PLATO trial: do you believe in magic?

Off‐pump coronary artery surgery

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