Pacemaker-Induced Hypotension

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.