Anaesthesia for neuroradiology

Abstract

There is a paucity of robust evidence for the best anaesthetic practice in this cohort of patients. Airway protection seems to be an issue in 2.5% of cases. Timing of the procedure is vital, and any delay may be detrimental to neurological outcome. In a survey of neurointerventionalists, the main concern they expressed was the potential delay to revascularization posed by anaesthesia. Patients complain of pain during mechanical clot retrieval if awake. The overall consensus seems to be favouring conscious sedation over general anaesthesia in the acute setting.

National trends in nonoperating room anesthesia: procedures, facilities, and patient characteristics

“…Although these neuroradiology procedures are conducted in radiology suites and mixed MRI suites today, conversations around the most appropriate anesthesia technique will continue to impact their setting in the future. Given some concerns by neurointerventionalists that recovery from general anesthesia may delay postprocedural neurological examination, lighter sedation will likely continue to be the requested modality in some cases [36]. One consideration for future trends is that, given the emergent nature of these procedures, patient outcomes may be compromised in cases not involving anesthesia staff.…”

Outcomes After Endovascular Therapy With Procedural Sedation vs General Anesthesia in Patients With Acute Ischemic Stroke

“…There is uncertainty regarding the role of general anesthesia and procedural sedation on functional outcomes, and guidelines give no formal recommendation owing to sparse evidence . Previous studies have suggested that general anesthesia produces worsening of functional outcomes due to arterial hypotension; thus, preference is often given to using procedural sedation . Although procedural sedation may allow faster procedure initiation, there is uncertainty regarding possible risks, including aspiration pneumonia in patients with unprotected airways and procedural complications due to patient movement and agitation, which may alter reperfusion and affect outcomes, thus counterbalancing potential benefits .…”

“…4 Previous studies have suggested that general anesthesia produces worsening of functional outcomes due to arterial hypotension; thus, preference is often given to using procedural sedation. 5,6 Although procedural sedation may allow faster procedure initiation, there is uncertainty regarding possible risks, including aspiration pneumonia in patients with unprotected airways and procedural complications due to patient movement and agitation, which may alter reperfusion and affect outcomes, thus counterbalancing potential benefits. 4,7 To our knowledge, 3 single-center randomized clinical trials and 1 multicenter randomized clinical trial have compared general anesthesia and procedural sedation, but all failed to show superiority for the primary end point.…”