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September 1973

Pacemaker-Induced Hypotension

Author Affiliations

San Diego, Calif

Arch Surg. 1973;107(3):363. doi:10.1001/archsurg.1973.01350210001001

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In 1966, several groups suggested the use of pacemaker-induced hypotension as a method of reducing brain blood flow and hemorrhage when a cerebral aneurysm ruptured.1-3 In an article in this issue of the Archives (See pp 374-378), Rovit and co-workers round off a series, previously published.4 They suggest that pacemaker-induced hypotension has become a useful tool in the surgical management of patients with cerebral aneurysms.

The threat of a rupture during operation for a cerebral aneurysm has led to the development of the following surgical and anesthetic approaches, which aim to reduce the risk of rupture: an anesthetic technique which not only avoids hypertension, momentary or continuous, but provides for controlled hypotension by posture and pharmacologic means; the control of brain volume by osmotic agents and arterial-blood carbon dioxide partial pressure regulation; sometimes a reduction of metabolism by moderate hypothermia; and always a deliberate and meticulous surgical technique.

Brown AS, Horton JM:  Elective hypotension with intracardiac pacemaking in the operative management of ruptured intracranial aneurysms . Acta Anaesthesiol Scand 10:( (suppl 23) ):665-670, 1966.Article
Small JM, et al:  Elective circulatory arrest by artificial pacemaker . Lancet 1:570-572, 1966.Article
Campkin TV, Dallas SH:  Elective circulatory arrest in neurosurgical operations . Br J Anaesth 40:527-531, 1968.Article
Rovit RL:  Operative hypotension for intracranial vascular surgery using pacemaker-induced ventricular tachycardia . J Neurosurg 35:15-58, 1971.Article