Page 104 - BH-2-3

Brain & Heart

CASE REPORT
Adenosine-induced cardiac standstill in

intracranial aneurysm surgery: A case report

†
Geraldine Raphaela B. Jose * , Cristina C. Arcinue-Gomez † ,
Lalaine O. Abainza , Katrina Xenia H. Figueroa-Piscawen , Glenn C. Chavez ,
Christian Rofem P. Quirimit , and Gerardo D. Legaspi
Department of Anesthesiology, Division of Neuroanesthesia, University of the Philippines, Philippine
General Hospital, Manila, Philippines

Abstract

Surgical clipping of complex intracranial aneurysms can pose intraoperative
challenges due to difficulty in anatomic exposure and uncontrolled intraoperative
rupture, leading to significant morbidities or mortalities. This report presents a
case of a 61-year-old Asian male with an unruptured saccular basilar tip aneurysm
and an unruptured right middle cerebral artery aneurysm. The patient underwent
a left temporal craniotomy and clipping of an unruptured basilar tip aneurysm,
successfully achieved through adenosine-induced cardiac standstill. This technique
reduces perfusion pressure and decreases the turgor of the aneurysm, thereby
facilitating clip ligation. Our experience demonstrated that thorough, careful patient
selection, optimal anesthetic management, and proper communication between
† These authors contributed equally
to this work. neurosurgeon and anesthesiologist are important for achieving successful surgical
outcomes.
*Corresponding author:
Geraldine Raphaela B. Jose
(gbjose@up.edu.ph)
Keywords: Adenosine-induced cardiac standstill; Complex intracranial aneurysm;
Citation: Jose GRB, Arcinue- Aneurysm clipping anesthesia; Adenosine cardiac arrest; Flow arrest in intracranial
Gomez CC, Abainza LO, et al.
Adenosine-induced cardiac aneurysm
standstill in intracranial aneurysm
surgery: A case report. Brain &
Heart. 2024;2(3):3394.
doi: 10.36922/bh.3394 1. Introduction
Received: April 9, 2024
Intracranial aneurysms pose a significant global health warning, leading to debilitating
Accepted: July 31, 2024 morbidities and mortalities, with an overall worldwide incidence of approximately
Published Online: August 26, 2024 6.1/100,000 and a global prevalence of 8.09 million cases. 2
1
Copyright: © 2024 Author(s). A comprehensive analysis of 24 distinct studies between 1984 and 2018 described
This is an Open-Access article three approaches indicating cardiac standstill for aneurysm surgery: (i) adenosine-
distributed under the terms of the
Creative Commons Attribution induced cardiac arrest (AiCS) for aneurysms with wide necks, thin walls, and restricted
License, permitting distribution, surgical visibility; (ii) rapid ventricular pacing to diminish ventricular contractility; and
and reproduction in any medium, (iii) profound hypothermic circulatory arrest. AiCS is especially beneficial for cases
3
provided the original work is
properly cited. involving giant or complex aneurysms, which are strongly linked to higher rates of
perioperative morbidity and mortality.
Publisher’s Note: AccScience
Publishing remains neutral with Limited case studies have explored the use of AiCS in intracranial aneurysm surgery.
regard to jurisdictional claims in 4
published maps and institutional Luostarinen et al. reported on 16 patients who received single or multiple boluses of
affiliations. adenosine, totaling 12 – 29 mg IV (intravenous). All patients were hemodynamically

Volume 2 Issue 3 (2024) 1 doi: 10.36922/bh.3394