Transient cardiac standstill induced by adenosine in the management of intraoperative aneurysmal rupture: Technical case report

OBJECTIVE AND IMPORTANCE: Intraoperative aneurysmal rupture represents a po tentially catastrophic event. We describe the use of an intravenous adenosi ne bolus to induce transient cardiac asystole to control a severe intraoper ative aneurysmal rupture. This treatment resulted in a brief period of seve re hypotension, which enabled successful clipping of the aneurysm. CLINICAL PRESENTATION: A 55-year-old man was referred to our institution 7 days after experiencing a mild subarachnoid hemorrhage from a fusiform, mul tilobulated aneurysm of the anterior communicating artery. The patient was found to have multiple additional fusiform aneurysms as well as a large par ietal arteriovenous malformation. INTERVENTION: A craniotomy was performed to clip the aneurysm, but surgical dissection was complicated by premature rebleeding that could not be contr olled satisfactorily with tamponade or temporary arterial occlusion. Infusi on of adenosine resulted in the vapid onset of profound hypotension, allowi ng for safe completion of the dissection and clipping of the aneurysm with a good outcome. There were no complications identified in relation to the u se of adenosine. CONCLUSION: In the setting of severe intraoperative aneurysmal rupture, int ravenous adenosine represents a potential means of achieving a near-immedia te profound decrease in the blood pressure that may allow for safe completi on of the dissection and aneurysm clipping.