Anesthesia care in the interventional neuroradiology suite: an update

Abstract

Purpose of reviewThe scope of procedures conducted by neurointerventionalists is expanding quickly, with lacking consensus over the best anesthesia modality. Although the procedures involve all age groups, the interventions may be complex and lengthy and may be provided in hospitals currently not yet familiar with the field. Here we review current literature addressing elective outpatient neurointerventional procedures and aim to provide an update on the management of intervention-specific crises, address special patient populations, and provide key learning points for everyday use in the neurointerventional radiology suite. Recent findingsVarious studies have compared the use of different anesthesia modalities and preinterventional and postinterventional care. Monitored anesthesia care is generally recommended for elderly patients, whereas children are preferably treated with general anesthesia. Additional local anesthesia is beneficial for procedures, such as percutaneous kyphoplasty and vascular access.

General Versus Nongeneral Anesthesia for Middle Meningeal Artery Embolization for Chronic Subdural Hematomas: Multicenter Propensity Score Matched Study

“…Non-GA approaches are becoming more common in neurointervention. 9 Although cerebral diagnostic digital subtraction angiography is usually performed without GA, most interventional procedures are performed under GA. 5 General anesthesia was found to be equally safe to non-GA in carotid endarterectomy, 10 but the results are mixed in patients undergoing intra-arterial therapy for acute ischemic stroke. 11,12 To the best of our knowledge, such comparisons have not yet been made for MMAE.…”

Reply to “Epidemiologic analysis of 8000 acute vertebral fractures: evolution of treatment and complications at 10-year follow-up”: food for thought outside the box

“…First, the authors state that fewer surgical therapies were performed before and after the 10-year study period. Nowadays, however, non-surgeons such as interventional neuroradiologists [2] also perform vertebroplasty and kyphoplasty [3]. Despite an increase in the need for early reoperation, overall and 5-year reoperation rates were comparable for non-surgical and surgical interventionists alike [3].…”

“…Moreover, the type of anaesthesia-such as local anaesthesia-might help prevent refractures [6]. Local anaesthesia for vertebroplasty or kyphoplasty is safe and regularly used in neurointerventional radiology [2]. Both patient positioning and anaesthesia type should be optimised by close interdisciplinary collaboration.…”

“…Author details 1 Emergency Department, Sonnenhof Hospital, Bern, Switzerland. 2 Department of Anesthesiology, Spitalregion Rheintal, Werdenberg, Sarganserland, Grabs, Switzerland. 3…”

Adjuvant Analgesics in Acute Pain – Evaluation of Efficacy

“…Therefore, it is essential to effectively manage acute pain [10][11][12][13][14]. Although opioids are often used in the management of postoperative pain due to their effectiveness in alleviating even severe pain, their side effects, such as sedation, respiratory depression, postoperative nausea and vomiting (PONV) and impaired bowel function can extend the duration of hospitalization [15].…”