High-Dose Adenosine Administration in an Asynchronously Paced Patient During Intracranial Aneurysm Clipping: A Case...

Area of Science:

• Cardiovascular Medicine
• Neurosurgery
• Anesthesiology

Background:

• Managing cerebral perfusion pressure is critical during cerebrovascular surgery.
• Patients with high ventricular pacing burden pose unique challenges for induced hypotension.
• Cardiac Resynchronization Therapy with Defibrillation (CRT-D) devices complicate the use of adenosine for asystystole induction.

Purpose of the Study:

• To evaluate the efficacy of adenosine for controlled hypotension in a patient with a CRT-D device undergoing cerebral aneurysm clipping.
• To determine if adenosine can induce predictable hypotension despite continuous ventricular pacing.

Main Methods:

• The patient's CRT-D device was reprogrammed to dual pace, no sense, no response (DOO) mode with defibrillation disabled.
• Adenosine boluses were administered during the cerebral aneurysm clipping procedure.
• Hemodynamic responses, specifically blood pressure, were monitored.

Main Results:

• Adenosine administration resulted in predictable hypotension.
• Hypotension was achieved despite uninterrupted ventricular pacing.
• The technique proved effective for temporary cerebral flow control.

Conclusions:

• Adenosine can be a safe and effective hypotensive agent in continuously paced patients.
• Device reprogramming offers a viable strategy for utilizing adenosine in complex neurosurgical cases.
• This approach expands the armamentarium for managing cerebral perfusion pressure during cerebrovascular surgery.