Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation: dose-response data and safety profile.
Abstract
BACKGROUND: Adenosine-induced transient flow arrest has been used to facilitate clip
ligation of intracranial aneurysms. However, the starting dose that is most likely
to produce an adequate duration of profound hypotension remains unclear. We reviewed
our experience to determine the dose-response relationship and apparent perioperative
safety profile of adenosine in intracranial aneurysm patients. METHODS: This case
series describes 24 aneurysm clip ligation procedures performed under an anesthetic
consisting of remifentanil, low-dose volatile anesthetic, and propofol in which adenosine
was used. The report focuses on the doses administered; duration of systolic blood
pressure <60 mm Hg (SBP(<60 mm Hg)); and any cardiovascular, neurologic, or pulmonary
complications observed in the perioperative period. RESULTS: A median dose of 0.34
mg/kg ideal body weight (range: 0.29-0.44 mg/kg) resulted in a SBP(<60 mm Hg) for
a median of 57 seconds (range: 26-105 seconds). There was a linear relationship between
the log-transformed dose of adenosine and the duration of a SBP(<60 mm Hg) (R(2) =
0.38). Two patients developed transient, hemodynamically stable atrial fibrillation,
2 had postoperative troponin levels >0.03 ng/mL without any evidence of cardiac dysfunction,
and 3 had postoperative neurologic changes. CONCLUSIONS: For intracranial aneurysms
in which temporary occlusion is impractical or difficult, adenosine is capable of
providing brief periods of profound systemic hypotension with low perioperative morbidity.
On the basis of these data, a dose of 0.3 to 0.4 mg/kg ideal body weight may be the
recommended starting dose to achieve approximately 45 seconds of profound systemic
hypotension during a remifentanil/low-dose volatile anesthetic with propofol induced
burst suppression.
Type
Journal articleSubject
AdenosineAdult
Aged
Anesthesia, General
Anesthetics, Inhalation
Anesthetics, Intravenous
Atrial Fibrillation
Cardiovascular Diseases
Cerebrovascular Circulation
Dose-Response Relationship, Drug
Female
Humans
Intracranial Aneurysm
Ligation
Male
Middle Aged
Nervous System Diseases
Neurosurgical Procedures
Piperidines
Postoperative Complications
Propofol
Vasodilator Agents
Permalink
https://hdl.handle.net/10161/10241Published Version (Please cite this version)
10.1213/ANE.0b013e3181d65bf5Publication Info
Bebawy, John F; Gupta, Dhanesh K; Bendok, Bernard R; Hemmer, Laura B; Zeeni, Carine;
Avram, Michael J; ... Koht, Antoun (2010). Adenosine-induced flow arrest to facilitate intracranial aneurysm clip ligation: dose-response
data and safety profile. Anesth Analg, 110(5). pp. 1406-1411. 10.1213/ANE.0b013e3181d65bf5. Retrieved from https://hdl.handle.net/10161/10241.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Dhanesh Kumar Gupta
Professor of Anesthesiology
The overall theme of my research is the application of clinical pharmacology tools
to the individualization of the care of high-risk surgical patients, especially those
undergoing neurosurgical procedures. Current research focuses on creating pharmacokinetic-pharmacodynamic
models to allow simulation of dose-concentration-effect relationships that will result
in reduced toxicity while maximizing efficacy of intravenous opioids and hypnotics.
The perioperative period is a time when patie

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles
Works are deposited here by their authors, and represent their research and opinions, not that of Duke University. Some materials and descriptions may include offensive content. More info