Review Article

Cardiac Emergencies in Neurosurgical Patients

Table 7

Cardiac emergencies in different neurosurgical positions.

AuthorPatient
(age/sex)
ProcedureCardiac rhythmChange in positionManagement

Lateral, park bench
Takei et al. [53]61 y ♂Microvascular decompressionVT, VFYesCPR lateral
Jaiswal et al. [21]32 y ♂Retromastoid suboccipital craniotomyBradycardia, asystole, VF, AFNoAtropine, CPR, epinephrine, amiodarone
Usami et al. [22]3 patients [36–52 y; ♀ = 2, ♂ = 1]Temporal craniotomy
( = 1);
retrosigmoid craniotomy ( = 2)
Asystole ( = 3), bradycardia ( = 2) NoAtropine ( = 2); surgery interruption ( = 2)
Prabhakar et al. [23]40 y ♀Retromastoid suboccipital craniotomyAsystoleNoSurgery interruption
Raman Sharma et al. [26]60 y ♀Retromastoid suboccipital craniotomyBradycardia (recurrent), asystole (40 s, three episodes) NoSurgery interruption
Isabel et al. [29]48 y ♀Right retromastoid craniectomy, (glossopharyngeal neuralgia)Asystole, multiple episodes (up to 45 s)NoLidocaine, atropine; surgery interruption; transvenous pacing
Beltran and Mashour [54]2 patients [21 ♀, 69 ♀]Craniotomy (neurofibroma)
Lumbar corpectomy (metastasis)
Severe hypotension, PEA
Severe hypotension, PEA
Yes
Yes
Vasopressors, CPR, died
Vasopressors, CPR, died
Sitting
Stauber et al. [18]67 y ♀Epidural steroid in cervical spinePEAYesEpinephrine, CPR
Villeret et al. [55]34 y ♀Pituitary adenoma resectionAsystoleNoSternal punch, IV epinephrine
Hoell et al. [38]60 y ♀Cervical discectomyAsystole (20 s)NoInterruption surgery
Nagashima et al. [30]74 y ♀Suboccipital craniotomy (vagal rootlet section)AsystoleNoAtropine
Prone
Dooney [35]43 y ♂Lumbar discectomyAsystoleYesAtropine, adrenaline, CPR started in prone
Sharma et al. [36]32 y ♂Alcohol injection vertebral hemangiomaAsystoleNoAtropine
Miyahara et al. [50]87 y ♂Cervical laminectomyVF (5 min)UnknownCPR, defibrillation, treatment of hyperkalemia
Chen et al. [37]75 y ♀Lumbar vertebroplastySevere bradycardiaYesCPR, died
Sellery [25]♀, age not specifiedChiari malformationAsystole (20 s)NoAtropine, ephedrine
Brown et al. [39]60 ♀Thoracic spine decompression Pulseless VTNoDefibrillation
Faberowski and Gravenstein [34]54 y ♀Craniotomy
(parietotemporal AVM)
VT/VFYesWithdrawal CVC, lidocaine, precordial thump, CPR (supine), defibrillation, epinephrine; surgery postponed
Loewenthal et al. [28]53 ♀ Cerebellar meningiomaBradycardia, asystole (3 min)NoCPR (prone)
Albin et al. [43]2 patients [both 40 y ♂]Lumbar laminectomyAsystole in first and PEA in second patientYesCPR, both died
McCarthy et al. [45] 18 y ♀Posterior spinal fusion and instrumentationCardiac arrest YesCPR (supine), open cardiac massage, vasopressors
Dumont et al. [46]38 y ♂Atlantoaxial arthrodesisAsystole (minutes)YesSurgical field irrigation, rapid skin closure, CPR (supine)
Miranda and Newton [56]39 ♀Debulking of tumor and internal fixation of third thoracic vertebraVFNoDefibrillation