Inadequate Adenosine-Induced Flow Arrest During Intraoperative Basilar Aneurysm Surgery

Aneurysmal subarachnoid hemorrhage (SAH) is an acute neurologic emergency. We report the case of a 48-year-old male with massive SAH caused by ruptured aneurysm vertebrobasilar transition. During urgent craniotomy, due to re-rupture, adenosine was given for flow arrest but no sinus pause observed. Esmolol administered and strategies cerebral protection were implemented. The surgeon able clip patient discharged after 78 days without sequelae. highest dose did not result in efficient cardiac pause. Atropine one hour before could have contributed this. This highlights successfully managed refractory adenosine-induced arrest.