Josefin Grabert1*, Markus Velten1, Lars Eichhorn1, Mark Coburn1, Alexis Hadjiathanasiou2, Patrick Schuss2, Hartmut Vatter2 and Erdem Güresir2
1Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Germany
2Department of Neurosurgery, University Hospital Bonn, Germany
Rapid Ventricular Pacing (RVP) has been described for flow reduction in elective surgery of unruptured intracranial aneurysms. Our patient had a ruptured anterior inferior cerebellar artery aneurysm unfavorable for endovascular treatment. Surgical approach necessitated the semi-sitting position and RVP due to complicated proximal control. Transesophageal echocardiography during anesthesia induction revealed an atrial septal defect. Intraoperative RVP achieved effective hypotension and facilitated successful aneurysm occlusion. Though extensive cardiac workup was not possible in this non-elective surgery, no arrhythmias or complications (i.e., paradoxical air embolism) occurred. This case demonstrates a safe and effective execution of RVP in the semi-sitting position for surgical clip reconstruction surgery of a ruptured intracranial aneurysm in a patient exhibiting an atrial septal defect.
Grabert J, Velten M, Eichhorn L, Coburn M, Hadjiathanasiou A, Schuss P, et al. Rapid Ventricular Pacing in the Semi-Sitting Position for Non-Elective Aneurysm Surgery. Clin Surg. 2021; 6: 3328..