Adenosine-induced Profound Hypotension in Facilitating Intracranial Aneurysm Clipping – Our Institutional Experience

Abstract

ABSTRACT Introduction: Adenosine-induced transient hypotension and temporary cardiac asystole are one of the novel techniques for facilitating aneurysm clipping. Till now, extensive studies have been done and no major complications are notified. However, there is no standardised safe dose mentioned in the literature. Here, we share our experience with adenosine in intracranial aneurysm clipping in our institution. Methodology: A total of 15 cases have been studied where adenosine is used in variable dosage to attain required transient hypotension and cardiac asystole. The bolus dosage, duration of hypotension and asystole and post-operative complications are noted. Results: Adenosine dosage of 0.5 mg/kg was used to achieve necessary hypotension and thus facilitating aneurysm clipping. No significant complications are observed at this dose of adenosine. Conclusion: A bolus of adenosine can allow a transient asystole with temporary hypotension that decompresses the aneurysm sac and improves visualisation without the negative effects of prolonged hypotension and thus facilitating aneurysm clipping. We could achieve the required duration of asystole and hypotension with 0.5 mg/kg of adenosine without any notable complications.