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Anesth Analg 1987; 66:229-234
© 1987 International Anesthesia Research Society
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Clinical Experience with Adenosine for Controlled Hypotension during Cerebral Aneurysm Surgery

Anders Öwall, MD, Emeric Gordon, MD, Michael Lagerkranser, MD, Christer Lindquist, MD, Anders Rudehill, MD, and Alf Sollevi, MD

Received from the Departments of Anesthesia and Neurosurgery, Karolinska Hospital, Stockholm, Sweden.

Abstract

The cardiovascular effects of adenosine-induced hypotension were studied in 47 patients undergoing intracranial vascular surgery under neurolept anesthesia. Adenosine infusion (214 ± 18 µg · kg–1 min–1) decreased mean arterial pressure (MAP) by 42 ± 1% from 80 ± 1 to 46 ± 1 mm Hg for an average of 29 ± 5 min of hypotension. Hypotension was associated with a minor increase in heart rate (13 ± 2%) and with prolongation of the PR interval (9 ± 2%). ST-T depression did not occur except in one patient with a previous history of myocardial infarction. The adenosine-induced increase in cardiac index (42 ± 9%, n = 7) was associated with a 63 ± 10% decrease in systemic vascular resistance index (n = 7) while the pulmonary capillary wedge pressure remained unchanged. Adenosine metabolism was limited and there was no accumulation of the end metabolite, uric acid. Serum creatinine levels were normal in all patients postoperatively. We conclude that adenosine rapidly induces a stable and easily controlled hypotension in man without tachyphylaxis or rebound hypertension. There were no signs of renal or myocardial dysfunction except for dysrhythmias that occurred in two patients with a history of myocardial infarction.

Key Words: ANESTHETIC TECHNIQUES—adenosine • ANESTHESIA—neurosurgical




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1987 by the International Anesthesia Research Society.