Cardiac standstill and neurosurgery

Complex intracranial aneurysm (ICA), large arteriovenous malformations and skull base tumours require absolute clean operative field and can be a battle of nerve testing at time due to torrential bleed. As such, there are various ways to reduce blood loss; however, maintaining cerebral perfusion during bleeding is a challenge. Currently, adenosine, hypothermia with cardiopulmonary bypass and rapid ventricular pacing (RVP) are options adopted at various places. Which one to choose may be a difficult preposition as there are several factors in its determinacy. This systematic review conforming to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines evaluated 52 full-text articles for 2000–2022. A search of PubMed was done with keywords adenosine OR, hypothermia, OR RVP, OR cardiac stand still and ICA [All Fields]. Case reports and only abstracts were excluded. After exclusions, 26 articles were analysed. The relevant information for each modality has been tabulated. Adenosine produces short asystole as compared to RVP. Adenosine can be repeated if need arises. For hypothermia and RVP, one would need a good set-up with intense monitoring and complex logistics. There can be many complex situations where neurosurgeons may still need any of the above methods to choose for variable reasons or indications. Choosing any of the above methods is largely guided by individual set-ups; however, the use of adenosine seems to be simple and easy.