Anesthetic Management of Interventional Neuroradiological Procedures

摘要

Rapid advances in endovascular surgery have created new opportunities and challenges for the treatment of brain diseases. There have been advances in catheter technology, imaging techniques, computational methods, new pharmacologic agents, and better understanding of drug delivery. In general, interventional neuroradiological (MR) or endovascular neurosurgical procedures are technically simple, yet they carry a low but significant morbidity. Although 0.2% to 1% of the patients may develop transient or permanent neurologic symptoms after diagnostic cerebral angiography, therapeutic interventions carry significantly greater risks of neurologic complications. The primary goals of anesthesia for INR procedures are to control the level of sedation in a manner that permits prompt neurologic examination, to render the patient immobile, and to manipulate cerebral hemodynamics. Many MR procedures (such as diagnostic angiography, carotid stenting, and embolization of cerebral arteriovenous malformations [AVMs]) can be undertaken with intravenous sedation. However, a growing number of MR procedures (such as aneurysm embolization, intracranial angioplasty, and embolization of some high-flow AVMs), require general anesthesia. General anesthesia is usually required for diagnostic procedures in children, in uncooperative patients, those at risk of aspiration or unable to protect the airway, and for prolonged procedures, such as those on the spinal cord. Often, the choice of anesthetic technique is a collaborative decision by the radiologist and the anesthesiologist, based on individual patient assessment.