Update on transient cardiac standstill in cerebrovascular surgery
- 1 May 2015
- journal article
- Published by Springer Science and Business Media LLC in Neurosurgical Review
- Vol. 38 (4), 595-602
- https://doi.org/10.1007/s10143-015-0637-z
Abstract
Transient cardiac standstill is a complementary procedure used with microsurgery to treat patients with particularly complex aneurysms, such as large or giant cerebral aneurysms. These procedures allow the aneurysms to be decompressed while maintaining a bloodless field and increased surgical exposure. Deep hypothermia combined with circulatory arrest provides cerebroprotection with optimal surgical conditions. However, its disadvantage is the relatively high risk of the procedure, which requires extensive expertise and infrastructure. Thus, its use is typically limited to patients with complex posterior circulation aneurysms. Adenosine-induced transient asystole is an easily applied technique in a variety of clinical situations. Its use requires minimal advanced preparation and no complex logistical coordination with other subspecialties. However, patient-specific dose-response relationships must be determined by exposure, so the relationship may not be known in an emergent situation. Persistent hypotension is a potentially major complication. Rapid ventricular pacing (RVP) has recently been reintroduced into cerebrovascular surgery. It is more predictable than adenosine in response time and, thus, can be used during unanticipated complications, such as aneurysmal rupture. It also induces a shorter period of hypotension compared with adenosine. However, RVP is more invasive and more complex from an anesthesia standpoint. Vascular neurosurgeons should be familiar with these techniques and know their applications and limitations.Keywords
This publication has 38 references indexed in Scilit:
- Rapid Ventricular Pacing for Flow Arrest During Cerebrovascular SurgeryOperative Neurosurgery, 2012
- Predictors of Clinical and Angiographic Outcome After Surgical or Endovascular Therapy of Very Large and Giant Intracranial AneurysmsNeurosurgery, 2011
- Adenosine-induced Transient Asystole for Intracranial Aneurysm SurgeryJournal of Neurosurgical Anesthesiology, 2011
- Perioperative Hypothermia (33°C) Does Not Increase the Occurrence of Cardiovascular Events in Patients Undergoing Cerebral Aneurysm SurgeryAnesthesiology, 2010
- Adenosine-Induced Flow Arrest to Facilitate Intracranial Aneurysm Clip LigationAnesthesia & Analgesia, 2010
- Adenosine-induced cardiac arrest during intraoperative cerebral aneurysm ruptureWorld Neurosurgery, 2010
- Circulatory arrest and deep hypothermia for the treatment of complex intracranial aneurysms—results from a single European centerActa Neurochirurgica, 2010
- Risk of recurrent subarachnoid haemorrhage, death, or dependence and standardised mortality ratios after clipping or coiling of an intracranial aneurysm in the International Subarachnoid Aneurysm Trial (ISAT): long-term follow-upThe Lancet Neurology, 2009
- Cold as a therapeutic agentActa Neurochirurgica, 2006
- Hypothermic circulatory arrest and the management of giant and large cerebral aneurysmsSurgical Neurology, 1993