Anesthetic Consideration for Neurointerventional Procedures

Joung, Kyung Woon; Yang, Ku Hyun; Shin, Won-Jung; Song, Myung Hee; Ham, Kyung-Don; Jung, Seung Chul; Lee, Deok Hee; Suh, Dae Chul

doi:10.5469/neuroint.2014.9.2.72

Cited by 19 publications

(22 citation statements)

References 32 publications

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“…Endovascular neurointervention through transfemoral catheter has been a preferred technique for diagnosis and treatment of neurovascular abnormalities such as arteriovenous malformations and aneurysms by providing images of blood vessels in and around the brain [12,34]. For some applications, endovascular neurointervention may provide better images than less invasive images such as computed tomography angiography and magnetic resonance angiography.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, endovascular neurointervention enables operators to treat disease immediately, based on its findings. For the interventional procedure for neurovascular abnormalities, metal coils or stents may be introduced through the femoral catheter already in place and maneuvered to the site of aneurysm [12]. In our study, patients had neurovascular diseases including cerebral aneurysm, arterio-venous malformation, and internal carotid artery stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, no specific reports on smooth emergence in patients going through endovascular neurointervention with sevoflurane anesthesia have been found. In particular, neurointervention is characterized by a procedure with minimal pain that requires a smaller dose of remifentanil for smooth emergence than other painful invasive surgeries [12].…”

Section: Introductionmentioning

confidence: 99%

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Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention

et al. 2019

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During emergence from general anesthesia, coughing caused by the endotracheal tube frequently occurs and is associated with various adverse complications. In patients undergoing endovascular neurointervention, achieving smooth emergence from general anesthesia without coughing is emphasized since coughing is associated with intracranial hypertension. Therefore, the up-and-down method was introduced to determine the effective effect-site concentration (Ce) of remifentanil to prevent coughing in 50% and 95% (EC 50 and EC 95 ) of patients during emergence from sevoflurane anesthesia for endovascular neurointervention. A total of 43 participants, American Society of Anesthesiologists class I or II participants, aged from 20 to 70 years who were undergoing endovascular neurointervention through transfemoral catheter for cerebrovascular disease were enrolled. Using the up-and-down method with isotonic regression, the EC 50 and EC 95 of remifentanil to prevent coughing during emergence from sevoflurane anesthesia were determined. We also investigated differences of hemodynamic and recovery profiles between the cough suppression group and the cough group. In total, 38 of 43 patients were included for estimation of EC 50 and EC 95 . The EC 50 and EC 95 of remifentanil to prevent coughing were 1.42 ng/mL (95% confidence interval [CI], 1.28–1.56 ng/mL) and 1.70 ng/mL (95% CI, 1.67–2.60 ng/mL), respectively. There was comparable emergence and recovery data between the cough suppression group (n = 22) and the cough group (n = 16). However, the Ce of remifentanil and total dose of remifentanil were significantly higher in the cough suppression group (P = 0.002 and P = 0.004, respectively). Target-controlled infusion of remifentanil at 1.70 ng/mL could effectively prevent extubation-related coughing in 95% of neurointervention patients, which could ensure smooth emergence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention

et al. 2019

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“…Although there is no clear decision concerning what type of anesthesia is superior, general anesthesia (GA) is more advantageous than sedation to preserve the intracranial pressure (ICP). Controlled ventilation during GA can provide normocapnia to control the ICP (2).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Two Methods of Anesthesia Using Patient State Index: Propofol Versus Sevoflurane During Interventional Neuroradiology Procedure

2019

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Background Over the past few decades, interventional neuroradiology (INR) has been a rapidly growing and evolving area of neurosurgery. Sevoflurane and propofol are both suitable anesthetics for INR procedures. While the depth of anesthesia is widely monitored, few studies have examined the patient state index (PSI) during clinical neuroanesthesia. Objectives This study aimed to investigate the differences in PSI values and in hemodynamic variables between sevoflurane anesthetic and propofol anesthetic during INR procedures. Methods We reviewed the medical charts of the patients who underwent embolization of a non-ruptured intracranial aneurysm by a single operator at a single university hospital from May 2013 to December 2014. Sixty-five patients were included and divided into two groups: S group (sevoflurane anesthesia, n = 33) vs. P group (propofol anesthesia, n = 32). The PSI values, hemodynamic variables, and use of hemodynamic drugs between two groups were analyzed. Results There were significant differences between the PSI values obtained through different perioperative stages in the two groups (P < 0.0001). During the procedure, the PSI values were significantly lower in the P group than in the S group (P = 0.000). The P group patients had a more prolonged extubation time (P = 0.005) and more phenylephrine requirement than the S group patients (P = 0.007). More anti-hypertensive drugs were administered to the patients in the S group during extubation (P = 0.0197). Conclusions The PSI can be used to detect changes in anesthetics concentration and in the depth of anesthesia during INR procedures. Although the extubation was faster under sevoflurane anesthetic, propofol anesthetic showed rather smoother recovery.

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“…1 At most centers, coil embolization for ruptured intracranial aneurysm (RIA) is performed under general anesthesia (GA), which provides optimal conditions for the procedure. 2 However, GA does not allow the evaluation of neurological status during the procedure, and several complications are associated with mechanical ventilation and anesthetics. 3 At our institution, we performed EVT under local anesthesia (LA) with conscious sedation (CS) for all patients with RIA, regardless of the clinical severity of the subarachnoid hemorrhage (SAH).…”

Section: Introductionmentioning

confidence: 99%

Feasibility, Safety, and Follow-up Angiographic Results of Endovascular Treatment for Non-Selected Ruptured Intracranial Aneurysms Under Local Anesthesia with Conscious Sedation

Kang

Roh

et al. 2018

J Neurocrit Care

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Background: At most centers, general anesthesia (GA) has been preferred for endovascular treatment (EVT) of ruptured intracranial aneurysms (RIAs). In this study, we analyzed procedural results, clinical outcomes, and follow-up angiographic findings for patients undergoing EVT for RIA under local anesthesia (LA) with conscious sedation (CS). Methods: We retrospectively evaluated 308 consecutive patients who underwent EVT for RIAs at a single institution between June 2009 and February 2017. EVT under LA with CS was considered for all patients with aneurysmal subarachnoid hemorrhage, regardless of Hunt and Hess (HH) scale score. Results: EVT was performed for 320 aneurysms in 308 patients with subarachnoid hemorrhages. The mean patient age was 55.5±12.6 years. Moderate (III) and poor (IV, V) HH grades were observed in 75 (24.4%) and 77 patients (25%), respectively. Complete occlusion immediately after EVT was achieved for 270 (84.4%) of 320 aneurysms. Thromboembolic complications and intraprocedural ruptures occurred in 25 (7.8%) and 14 cases (4.3%), respectively. The morbidity rate at discharge (as defined by a modified Rankin scale score of 3 or greater) was 27.3% (84/308), while the mortality rate was 11.7% (36/308). Followup angiographic results were available for 210 (68.1%) of 308 patients. Recanalization was observed in 64 (29.3%) of 218 aneurysms in 210 patients. Conclusion: Based on our experience, EVT for RIAs under LA with CS was feasible, regardless of the clinical grade of the subarachnoid hemorrhage. Complication rates and follow-up angiographic results were also comparable to those observed when GA was used to perform the procedure.

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Anesthetic Consideration for Neurointerventional Procedures

Cited by 19 publications

References 32 publications

Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention

Effect-site concentration of remifentanil for smooth emergence from sevoflurane anesthesia in patients undergoing endovascular neurointervention

Comparison of Two Methods of Anesthesia Using Patient State Index: Propofol Versus Sevoflurane During Interventional Neuroradiology Procedure

Feasibility, Safety, and Follow-up Angiographic Results of Endovascular Treatment for Non-Selected Ruptured Intracranial Aneurysms Under Local Anesthesia with Conscious Sedation

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