Adenosine-induced ventricular asystole to induce transient profound systemic hypotension in patients undergoing endovascular therapy: Dose-response characteristics
Background: Adenosine-induced asystole has been used to induce transient systemic hypotension for various vascular procedures. Dose-response characteristics of adenosine-induced ventricular asystole have not been determined. Methods: During endovascular embolization of cerebral arteriovenous malformations, the authors performed a series of adenosine test injections to establish a dose-response relation in each patient. After an interval of 3-10 min, the dose was escalated by 10-20 mg for each injection to achieve an end point of 20-30 s of stable mean arterial pressure (MAP) reduction to 25-30 mmHg. All patients received constant infusion of nitroprusside (≃ 1 μg · kg-1 · min-1) throughout the procedure. Results: The authors studied four adult patients (age, 22-44 yr; two patients had two separate procedures) 31y 1600 Divisadero Streetand one pediatric patient (age, 4 yr). Twenty-three adenosine injections resulted in measurable asystole. The adenosine dose was 0.98 ± 0.40 mg/kg (mean ± SD), and the dose range was 0.24-1.76 mg/kg (6-90 mg). The duration of asystole, MAP < 30 mmHg, and MAP < 50 mmHg, were 8 ± 3 s, 18 ± 12 s, and 50 ± 29 s, respectively. The minimum MAP and the MAP for the first 20 s were 16 ± 3 mmHg and 30 ± 9 mmHg, respectively. There was a linear relation between adenosine dose and the duration of hypotension with MAP < 30 mmHg and MAP < 50 mmHg. Conclusions: In the dose range studied, a series of adenosine test injections can be used to determine optimal adenosine dose for induction of transient profound hypotension.
Cerebrovascular disease, Induced hypotension, Interventional neuroradiology
Digital Object Identifier (DOI)
Hashimoto, Tomoki; Young, William L.; Aagaard, Beverly D.; Joshi, Shailendra; Ostapkovich, Noeleen D.; and Pile-Spellman, John, "Adenosine-induced ventricular asystole to induce transient profound systemic hypotension in patients undergoing endovascular therapy: Dose-response characteristics" (2000). Translational Neuroscience. 1658.