Anesthetic management of endovascular stent graft placement for thoracic aortic aneurysm using induction of transient cardiac asystole by ATP

We experienced anesthetic management of endovascular stent graft placement for thoracic aortic aneurysm in a 69-year-old patient. Under general anesthesia, ATP 20 mg was administered intravenously. However, heart rate and blood pressure did not decrease sufficiently for placement of a stent graft. After additional injection of ATP 30 mg, heart rate and systolic blood pressure decreased to 20 bpm and 60-70 mmHg, respectively, enabling the placement of a self-expanded type stent graft in the proper site. No clinical complications related to this procedure were observed. Induction of transient cardiac asystole by ATP is an easy and safe procedure for placement of a stent graft in a patient with thoracic aortic aneurysm.