Interventional Neuroradiological Procedures—A Review for Anaesthetists

Abstract

Interventional neuroradiology is a rapidly expanding field, and the complexity and duration of these procedures makes anaesthetic support essential to their success. Such has been the development in this area that the American Heart Association has published a scientific statement on the indications for these procedures. A detailed understanding of patient pathology, the technical aspects of the interventions and their associated risks, and the remote location in which they are performed are important for providing expert anaesthetic care. The aim of this article is to provide a description and contemporary analysis of the common interventional neuroradiology procedures relevant to the anaesthetist. This article will cover the management of intracranial aneurysms, cerebral vasospasm following intracranial haemorrhage, intracranial and spinal arteriovenous malformations, idiopathic intracranial hypertension, carotid artery stenting, intra-arterial thrombolysis for stroke and endovascular treatment of intracranial atherosclerosis. Protection from ionising radiation and acute kidney injury are also discussed.

Airway management in general anesthesia for endovascular treatment of cerebral arteriovenous malformation: a retrospective observational study

“…A rapid and smooth recovery is also important for assessing of the neurological status and early diagnosis of the post-procedural complications including bleeding, vasospasm, stroke, and focal deficits. 6 , 7 In our study, the recovery and discharge times were similar in both groups. This is attributable to use propofol, fentanyl, and rocuronium, an intermedium acting neuromuscular blocking agent for the induction of anesthesia and a TIVA technique based on the propofol and remifentanil infusions for the maintenance.…”

“…We have been also using routinely endotracheal intubation in general anesthesia for EVTs as recommended in the literature. 3 , 4 , 5 , 6 , 7 , 8 , 9 But, in our practice, the elevation of arterial blood pressure at intubation period induced by direct laryngoscopy, and cough and straining at the extubation periods were criticized by the neuroradiologist due to the risk for the development of an intracerebral hemorrhage, which is one of the leading factors causing morbidity and mortality.…”

“…Among the various anesthetic techniques such as conscious sedation, general anesthesia (GA), and neurolept anesthesia, GA is the most commonly used technique because it ensures both immobilization and airway safety during the procedure. Endotracheal intubation has been generally used for airway management in GA. 5 , 6 , 7 , 8 , 9 , 10 Although supraglottic airway devices are well-known tools for the airway management in GA, their use in the interventional neuroradiological procedures is limited. Only four reports exist in the literature.…”

Making Endovascular Neurosurgery Safer: Role of the Neuroanesthesiologist

“…Radiation exposure is directly proportional to the time of exposure and indirectly proportional to the square of the distance from the radiation source, and hence, the duration of exposure should be minimized and the distance from the source maximized. 67 Stationing of personnel at least 4 feet away from the radiation source, operating the fluoroscope at the lowest dose rate that yields adequate images, and monitoring the radiation time have been suggested to minimize radiation hazards. 5,61 Standing on the receiver side of the C-Arm to minimize scatter from the surface of the patient facing the radiation source is also suggested.…”

“…5,61 Standing on the receiver side of the C-Arm to minimize scatter from the surface of the patient facing the radiation source is also suggested. 67…”