Anesthetic Considerations for Endovascular Management of Intracranial Aneurysms

Abstract

Intra cranial aneurysms are acquired lesions responsible for about 80% of non-traumatic sub arachnoid hemorrhage. Treatment of the condition in the past has relied on craniotomy and clipping of the aneurysm to prevent a recurrent hemorrhage. Nowadays endovascular coiling is the best primary treatment. The anesthesia in interventional radiology room has special arrangement and precautions. Intra operative management of endovascular cerebral aneurysm from the start including: arrangement of the room, monitoring, induction, maintenance and emergence of the patients. Post-operative care is very important and good management of potential perioperative complications like: aneurysm rupture, cerebral infarction, cerebral vasospasm, contrast reaction and nephropathy is mandatory. Aim of the Study: reviewing the current medical literature as regards the anesthetic considerations and problems of endo-vascular management of intracranial aneurysm. Conclusion: anesthesia in interventional radiology room should have special arrangements and precautions. Intra operative management of endovascular cerebral aneurysm from the start including: arrangement of the room, monitoring, induction, maintenance and emergence of the patients. Post-operative care plays a key role in mitigating potential perioperative complications like: aneurysm rupture, cerebral infarction, cerebral vasospasm, contrast reaction and nephropathy are mandatory.

Making Endovascular Neurosurgery Safer: Role of the Neuroanesthesiologist

“…Reversal of heparin action is done with protamine (1:1 ratio). The interventionist rapidly packs the ruptured aneurysm with additional coils, and if that fails, emergency craniotomy and aneurysm clipping may be considered, though this is uncommon 5,6,38 ; external ventriculostomy is required if acute hydrocephalus develops. In case of a sudden massive intracranial catastrophe, deliberate hypothermia (33-34°C), hyperventilation and electroencephalography burst suppression using IV anesthetic agents has also been suggested.…”