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Hurtado P, Garcia-Orellana M, Amaro S, Carrero E, Zarco F, Lopez A, Fabregas N, Valero R. Use of second generation supraglottic airway device for endovascular treatment of unruptured intracranial aneurysms: a retrospective cohort. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 71:408-412. [PMID: 33915196 PMCID: PMC9373688 DOI: 10.1016/j.bjane.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/04/2021] [Accepted: 04/10/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND We aimed to assess the feasibility of using supraglottic devices as an alternative to orotracheal intubation for airway management during anesthesia for endovascular treatment of unruptured intracranial aneurisms in our department over a nine-year period. METHODS Retrospective single center analysis of cases (2010-2018). Primary outcomes: airway management (supraglottic device repositioning, need for switch to orotracheal intubation, airway complications). SECONDARY OUTCOMES aneurysm complexity, history of subarachnoid hemorrhage, hemodynamic monitoring, and perioperative complications. RESULTS We included 187 patients in two groups: supraglottic device 130 (69.5%) and orotracheal intubation 57 (30.5%). No adverse incidents were recorded in 97% of the cases. Three supraglottic device patients required supraglottic device repositioning and 1 supraglottic device patient required orotracheal intubation due to inadequate ventilation. Three orotracheal intubation patients had a bronchospasm or laryngospasm during awakening. Forty-five patients (24.1%) had complex aneurysms or a history of subarachnoid hemorrhage. Thirty-three of them (73.3%) required orotracheal intubation compared to 24 of the 142 (16.9%) with non-complex aneurysms. Two patients in each group died during early postoperative recovery. Two in each group also had intraoperative bleeding. A post-hoc analysis showed that orotracheal intubation was used in 55 patients (44%) in 2010 through 2014 and 2 (3.2%) in 2015 through 2018, parallel to a trend toward less invasive blood pressure monitoring from the earlier to the later period from 34 (27.2%) cases to 5 (8.2%). CONCLUSION Supraglottic device, like other less invasiveness protocols, can be considered a feasible alternative airway management approach in selected patients proposed for endovascular treatment of unruptured intracranial aneurisms.
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Affiliation(s)
- Paola Hurtado
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain
| | | | - Sergi Amaro
- Hospital Clínic de Barcelona, Neurology Department, Barcelona, Spain
| | - Enrique Carrero
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain
| | - Federico Zarco
- Hospital Clínic de Barcelona, Radiology Department, Barcelona, Spain
| | - Anna Lopez
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain
| | - Neus Fabregas
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain
| | - Ricard Valero
- Hospital Clínic de Barcelona, Anaesthesiology Department, Barcelona, Spain.
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Sharma MU, Ganjoo P, Singh D, Tandon MS, Agarwal J, Sharma DP, Jagetia A. Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective. Asian J Neurosurg 2017; 12:6-12. [PMID: 28413524 PMCID: PMC5379807 DOI: 10.4103/1793-5482.145106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period. METHODS Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications. Information regarding hemodynamic alterations, temperature variability, fluid-electrolyte imbalance, coagulation abnormalities and alterations in the anesthesia course was specifically noted. RESULTS Among the important complications observed were aneurysm rupture (2.5%), vasospasm (6.67%), thromboembolism (4.16%), contrast reactions, hemodynamic alterations, electrolyte abnormalities, hypothermia, delayed emergence from anesthesia, groin hematomas and early postoperative mortality (5.14%). CONCLUSION Awareness of the unique challenges of endovascular neurosurgery and prompt and appropriate management of the associated complications by an experienced neuroanesthesiologist is vital to the outcome of these procedures.
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Affiliation(s)
- Megha U Sharma
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Pragati Ganjoo
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Monica S Tandon
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Jyotsna Agarwal
- Department of Anaesthesiology and Intensive Care, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Durga P Sharma
- Department of Neurosurgery, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
| | - Anita Jagetia
- Department of Neurosurgery, GB Pant Hospital and Maulana Azad Medical College, New Delhi, India
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Rosero EB, Joshi GP. Ambulatory Anesthesia in Remote Locations. CURRENT ANESTHESIOLOGY REPORTS 2016. [DOI: 10.1007/s40140-016-0181-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Youn AM, Ko YK, Kim YH. Anesthesia and sedation outside of the operating room. Korean J Anesthesiol 2015; 68:323-31. [PMID: 26257843 PMCID: PMC4524929 DOI: 10.4097/kjae.2015.68.4.323] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022] Open
Abstract
Due to rapid evolution and technological advancements, medical personnel now require special training outside of their safe zones. Anesthesiologists face challenges in practicing in locations beyond the operating room. New locations, inadequate monitoring devices, poor assisting staff, unfamiliarity of procedures, insufficient knowledge of basic standards, and lack of experience compromise the quality of patient care. Therefore, anesthesiologists must recognize possible risk factors during anesthesia in nonoperating rooms and familiarize themselves with standards to improve safe practice. This review article emphasizes the need for standardizing hospitals and facilities requiring nonoperating room anesthesia, and encourages anesthesiologists to take the lead in applying these practice guidelines to improve patient outcomes and reduce adverse events.
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Affiliation(s)
- Ann Misun Youn
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Young-Kwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Yoon-Hee Kim
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea
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Guimond JG, Chagnon P, Bojanowski M. Clippage versus coiling dans le cas d’une hémorragie sous-arachnoïdienne par rupture d’anévrisme : la condition médicale du patient doit-elle influencer le choix du traitement ? Neurochirurgie 2012. [DOI: 10.1016/j.neuchi.2012.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Clipping vs. coiling in acute aneurysmal subarachnoid haemorrhage: Should the patient's medical condition influence treatment modality? Neurochirurgie 2012; 58:115-24. [PMID: 22464600 DOI: 10.1016/j.neuchi.2012.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Acute subarachnoid haemorrhage (SAH) resulting from aneurysmal rupture is a medical condition associated with significant morbidity and mortality. Medical complications resulting from the bleeding itself, along with the patient's underlying medical conditions are known to represent possible prognostic factors in acute SAH. However, their respective significance on the patient's overall clinical outcome following either endovascular coiling (EC) or surgical clipping (SC) remains to be ascertained as well as their potential role in choosing a definitive treatment option. We thus reviewed the evidence concerning the patient's medical condition as a factor in this decision making process. METHODOLOGY Source data were obtained from a MEDLINE search of the medical literature and by manual review of published randomised trials comparing EC to SC. RESULTS The last three decades allowed for detection of medical complications with increasing frequency in the context of SAH, as awareness for them has improved. Despite the fact that a patient's extra-neurological condition can be a significant prognostic factor after a SAH, our review demonstrates that medical conditions in general were not taken into consideration in randomized trials comparing EC to SC. Also, we found no analysis comparing the potential role of prior versus post-SAH medical conditions in choosing either therapeutic avenue. CONCLUSION It is not determined whether it is appropriate for SAH patients to be offered treatment for a ruptured aneurysm based mostly on anatomical criteria or if, within certain subgroups of patients, EC and SC should also be recommended in light of what the patient can tolerate from a medical standpoint. Although we hypothesize that in practice, the patient's medical condition is considered in the decision making process, it remains to be documented. Patient, aneurysm and institution-related factors are all interrelated, as is patient care. Data on all of these factors are thus needed and their analysis by association rather than by dissociation may be the key in answering our question.
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Perioperative hypothermia (33 degrees C) does not increase the occurrence of cardiovascular events in patients undergoing cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial. Anesthesiology 2010; 113:327-42. [PMID: 20571361 DOI: 10.1097/aln.0b013e3181dfd4f7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perioperative hypothermia has been reported to increase the occurrence of cardiovascular complications. By increasing the activity of sympathetic nervous system, perioperative hypothermia also has the potential to increase cardiac injury and dysfunction associated with subarachnoid hemorrhage. METHODS The Intraoperative Hypothermia for Aneurysm Surgery Trial randomized patients undergoing cerebral aneurysm surgery to intraoperative hypothermia (n = 499, 33.3 degrees +/- 0.8 degrees C) or normothermia (n = 501, 36.7 degrees +/- 0.5 degrees C). Cardiovascular events (hypotension, arrhythmias, vasopressor use, myocardial infarction, and others) were prospectively followed until 3-month follow-up and were compared in hypothermic and normothermic patients. A subset of 62 patients (hypothermia, n = 33; normothermia, n = 29) also had preoperative and postoperative (within 24 h) measurement of cardiac troponin-I and echocardiography to explore the association between perioperative hypothermia and subarachnoid hemorrhage-associated myocardial injury and left ventricular function. RESULTS There was no difference between hypothermic and normothermic patients in the occurrence of any single cardiovascular event or in composite cardiovascular events. There was no difference in mortality (6%) between groups, and there was only a single primary cardiovascular death (normothermia). There was no difference between hypothermic and normothermic patients in postoperative versus preoperative left ventricular regional wall motion or ejection fraction. Compared with preoperative values, hypothermic patients had no postoperative increase in cardiac troponin-I (median change 0.00 microg/l), whereas normothermic patients had a small postoperative increase (median change + 0.01 microg/l, P = 0.038). CONCLUSION In patients undergoing cerebral aneurysm surgery, perioperative hypothermia was not associated with an increased occurrence of cardiovascular events.
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Técnica de hipotermia profunda y paro circulatorio total para clipaje de aneurismas cerebrales gigantes. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2010. [DOI: 10.1016/s0120-3347(10)81008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lakhani S, Guha A, Nahser HC. Anaesthesia for endovascular management of cerebral aneurysms. Eur J Anaesthesiol 2006; 23:902-13. [PMID: 16723053 DOI: 10.1017/s0265021506000901] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2006] [Indexed: 11/06/2022]
Abstract
Subarachnoid haemorrhage due to rupture of cerebral aneurysms is a multisystem disease. Treatment of the condition in the past has relied on craniotomy and clipping of the aneurysm to prevent a recurrent haemorrhage. There is now emerging evidence to suggest that endovascular treatment of cerebral aneurysms may reduce the morbidity associated with open surgery. The anaesthetic management of interventional neuroradiology also creates new challenges due to the novel approach to treatment. Anaesthetists need to be familiar with this procedure and the management of potential complications. This review provides an overview such considerations.
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Affiliation(s)
- S Lakhani
- Walton Centre for Neurology and Neurosurgery, Department of Anaesthesia, Liverpool, UK
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Robbertze R, Posner KL, Domino KB. Closed claims review of anesthesia for procedures outside the operating room. Curr Opin Anaesthesiol 2006; 19:436-42. [PMID: 16829728 DOI: 10.1097/01.aco.0000236146.46346.fe] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The demand for anesthesia services is increasing due to more complex procedures being performed outside the operating room. We reviewed the literature and closed malpractice claims in the American Society of Anesthesiologists' Closed Claims database to assess liability and injury associated with anesthesia for procedures outside the operating room (nonoperating-room anesthesia, n = 24) compared with intra-operative surgical anesthesia (operating room, n = 1927) claims. RECENT FINDINGS A higher proportion of patients in nonoperating-room anesthesia claims underwent monitored anesthesia care (58 vs. 6%, P < 0.001) and were at the extremes of age (50 vs. 19%, P = 0.003) than in operating room claims. Half of the nonoperating-room anesthesia claims occurred in the gastrointestinal suite. Inadequate oxygenation/ventilation was the most common specific damaging event in nonoperating-room anesthesia claims (33 vs. 2% in operating room claims, P < 0.001). The proportion of death was increased in nonoperating-room anesthesia claims (54 vs. 24%, P = 0.003). Nonoperating-room anesthesia claims were more often judged as having substandard care (P = 0.003) and being preventable by better monitoring (P = 0.007). SUMMARY Nonoperating-room anesthesia claims had a higher severity of injury and more substandard care than operating room claims. Inadequate oxygenation/ventilation was the most common mechanism of injury. Maintenance of minimum monitoring standards and airway management training is required for staff involved in patient sedation.
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Affiliation(s)
- Reinette Robbertze
- Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington 98195-6540, USA
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Preiss H, Reinartz J, Lowens S, Henkes H. Anästhesiologisches Management bei neuroendovaskulären Eingriffen. Anaesthesist 2006; 55:679-92. [PMID: 16775731 DOI: 10.1007/s00101-006-1005-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The endovascular treatment of diseases of intracranial and spinal vessels has become widely accepted in recent years. The patient is usually treated under general anesthesia and in choosing an appropriate anesthesia regimen and an optimized pre-interventional preparation, the anesthesiologist can influence the postinterventional result. The working environment in the angiography suite should address the requirements of a routine procedure and the necessities of complication management. Application of short-acting narcotics and relaxation of the patient if required, facilitate the intervention for both the neuroradiologist and the anesthesiologist. The patient should be supplied with everything needed before the intervention to avoid any waste of time in the case of an emergency (e.g., haemorrhage or fibrinolytic treatment). After the procedure the patient has to be monitored for at least 24 h. Peri-interventional and postinterventional complications, such as thrombo-embolism or hemorrhage, must be managed aggressively and consequently by the anesthesist to improve the postinterventional outcome. Therefore a close collaboration between the anesthesiologist and the neuroradiologist is essential.
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Affiliation(s)
- H Preiss
- Abteilung Neuroradiologie und Radiologie, Robert Janker Klinik, Villenstrasse 4-8, 53129 Bonn.
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Allen G, Farling P, McAtamney D. Anesthetic management of the pregnant patient for endovascular coiling of an unruptured intracranial aneurysm. Neurocrit Care 2006; 4:18-20. [PMID: 16498190 DOI: 10.1385/ncc:4:1:018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Diagnosis of an intracranial aneurysm during pregnancy is a rare event requiring multidisciplinary care for successful management. The knowledge base for the anesthesiologist involves principles of both obstetric and neuroanesthesia, as well as critical care. This article reports such a case and discusses the relevant pathophysiology, along with details of the perioperative management by the anesthesiology team.
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Affiliation(s)
- G Allen
- Department of Anaesthesia, Ulster Hospital, Royal Victoria Hospital, Belfast, Northern Ireland.
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Steib A, Hausberger D, Robillart A, Roche A, Franckhauser D, Dupeyron JP. [Anaesthetic considerations for interventional radiology]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2006; 25:615-25. [PMID: 16632296 DOI: 10.1016/j.annfar.2006.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Accepted: 01/24/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the new procedures applied for interventional radiology leading to specific anaesthetic care and organization. DATA SOURCE Record of references from national and international journals in Medline. STUDY SELECTION All types of articles were selected including prospective studies, practice guidelines, reviews and case reports. DATA SYNTHESIS During interventional radiology, anaesthesia should be adapted to the duration of the procedure, the pain induced by the radiologist, the position of the patient and its medical status. General anaesthesia would be preferred for long procedures, requiring total immobility. Locoregional anaesthesia can be proposed for some cases. Sedation associating hypnotics (propofol, midazolam, sevoflurane) and opioids (alfentanil, remifentanil) is commonly used according to different schemes, as discontinuous boluses, continuous infusion, target controlled intravenous sedation or patient controlled sedation. Monitoring of temperature and diuresis may be useful for long procedures. Haemodynamic monitoring (arterial catheter, central venous pressure) and haemostatic monitoring may be necessary for interventional neuroradiology and endovascular stenting. Radiofrequency and laser procedures are often painful, requiring the choice of adequate analgesic regimen. Hydratation associated with acetylcysteine seems to be able to prevent contrast induced nephropathy in patients with risk factors for chronic renal insufficiency. CONCLUSION As advances in interventional radiology are obvious, general organisation as well as anaesthetic procedures should be adapted to these specific techniques.
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Affiliation(s)
- A Steib
- Département d'Anesthésiologie, Hôpital Civil, 1, Place de l'Hôpital, Hôpitaux Universitaires, 67091 Strasbourg Cedex, France.
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Niskanen M, Koivisto T, Rinne J, Ronkainen A, Pirskanen S, Saari T, Vanninen R. Complications and postoperative care in patients undergoing treatment for unruptured intracranial aneurysms. J Neurosurg Anesthesiol 2005; 17:100-5. [PMID: 15840997 DOI: 10.1097/01.ana.0000163202.33236.ml] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endovascular treatment has become a feasible alternative in the management of aneurysmal subarachnoid hemorrhage. After endovascular or surgical treatment of patients with unruptured intracranial aneurysms (UIAs), little is known about the practices of observation or need for intensive care. We analyzed retrospectively perioperative complications that were associated with the procedure and postoperative care in patients undergoing management of UIAs. A total of 53 patients underwent endovascular treatment and 105 patients surgical treatment. Location of the aneurysm was the main determinant of the modality of treatment. In the endovascular group, 34 patients were conscious during the procedure and 19 were under general anesthesia. Six patients in the endovascular and 9 in the surgical group experienced complications during the procedure. After the procedure, complications were more common in the surgical group than in the endovascular group (11 versus 0 patients, P = 0.015). Six of the postoperative complications of surgically treated patients occurred in the intensive care unit. Two patients in the endovascular group and five in the surgical group had major neurologic deficits as a consequence of complications. One surgically treated patient died. Both endovascular and surgical treatment of UIAs carry risks that may result in severe neurologic impairment. Patients should be observed with equal vigilance with either treatment option. Surgical treatment is associated with emergencies that require prompt interventions postoperatively and therefore close observation in an ICU setting may be preferable in patients who have undergone surgical treatment of UIAs. Complications after uneventful endovascular procedures seem to be rare.
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Affiliation(s)
- Minna Niskanen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, Kuopio, Finland.
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Jones M, Leslie K, Mitchell P. Anaesthesia for endovascular treatment of cerebral aneurysms. J Clin Neurosci 2004; 11:468-70. [PMID: 15177384 DOI: 10.1016/j.jocn.2004.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Accepted: 03/19/2004] [Indexed: 11/30/2022]
Abstract
Endovascular treatment of cerebral aneuryms is now widely used and has important implications for the neuroanaesthetist. Significant issues include the decision to use general anaesthesia, factors associated with anaesthesia in the interventional radiology suite and treatment of complications. As endovascular treatment is now supported by evidence and established in practice, neuroanaesthetists should be involved in planning these procedures from a process, and individual patient, perspective.
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Affiliation(s)
- M Jones
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
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Van de Velde M. Curr Opin Anaesthesiol 2003; 16:417-420. [DOI: 10.1097/00001503-200308000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Abstract
PURPOSE OF THE REVIEW The aim of this review is to give a general overview of anesthetic management, technical considerations and specific complications of interventional neuroradiology based on the most recent literature. RECENT FINDINGS In more and more services anesthetists become an integrated part in the management of patients treated with endovascular neurosurgery. More and more centers opt for general anesthesia using less invasive monitoring than with common neurosurgery. SUMMARY Interventional neuroradiology is challenging because of the location and the sudden and acutely life-threatening complications that may occur.
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Affiliation(s)
- Marc Van de Velde
- Department of Anesthesiology, Gasthuisberg University Hospitals, Leuven Catholic University, Leuven, Belgium.
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Yamada M, Nishikawa K, Kawahara F, Yoshikawa D, Saito S, Goto F. Anesthetic management for clipping a giant basilar artery aneurysm with moderate hypothermia, extracorporeal circulation assistance, and propofol infusion. J Neurosurg Anesthesiol 2003; 15:274-7. [PMID: 12826978 DOI: 10.1097/00008506-200307000-00018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 65-year-old female patient underwent surgery to clip a giant basilar artery aneurysm with closed-chest extracorporeal circulation using femorofemoral bypass. Moderate hypothermia (27 degrees C-30 degrees C), retention of spontaneous circulation, and propofol infusion (3-5 mg. kg(-1). h(-1)) were used under general anesthesia. Blood outflow via femoral vein was sufficient to maintain cardiopulmonary bypass and to induce hypothermia. Hemodynamics were controlled with dopamine and noradrenaline. In this case, extracorporeal circulation under moderate hypothermia was used to assist rather than substitute for spontaneous circulation, and spontaneous circulation was maintained at all times. We think that this method had advantages over deep hypothermic circulatory arrest with regard to intraoperative risks and postoperative complications.
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Affiliation(s)
- Makiko Yamada
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi City, Japan
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Affiliation(s)
- Irene P Osborn
- Department of Anesthesiology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029, USA
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Abstract
PURPOSE OF REVIEW The capabilities of interventional radiology are developing faster than perhaps any other branch of medicine. Coupled with and fuelled by parallel advances in computer technology, medical physics and developments in endovascular catheter technology, interventional radiologists are innovating not only replacements for open surgeries, but entirely new therapies as well. This has, however, provided a range of new potential complications for the patient and, in contrast to other areas, presents risks for the anesthesiologist as well. RECENT FINDINGS The techniques involved in interventional radiology have found applications throughout not only medicine but surgery in particular. Here there has been a medicalization of surgical procedures. CT scanning has evolved to the extent that it is now possible to utilize multislice CT scanners, ones with multiple, flat panel digital detectors, to provide real time CT fluoroscopy. Similarly this technology has facilitated the construction of hybrid iMR/X-ray systems, thus enabling dual modality imaging without moving the patient. Another facet of the new breed of iMR systems is their integration in real time with computerized, frameless stereotactic navigation systems. This has enabled the radiological image to keep pace with the changes in anatomy consequent to anesthetic and surgical manipulations. SUMMARY In the light of these new developments in interventional radiology there is much research to be done. Further developments in imaging and computer processing technology will doubtless make possible the real time integration of anatomical image with metabolic state and functional anatomy. The impact of the hazards of these new techniques on the safety of anesthesia has, however, been the subject of virtually no research. A particularly needy area will be the ergonomics of the delivery of anesthesia care in these new environments.
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