Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective

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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“…The neurointerventional treatment of cerebral aneurysms can be performed under local sedation or general anesthesia and has unique issues. 170 Sedation may be more advantageous for patients with significant systemic medical conditions; however, outcome data are lacking. Confusion or neurological impairment makes sedation challenging, whereas general endotracheal anesthesia ensures control of ventilation and immobility of the patient.…”

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Enhanced mechanical properties of poly(L‐lactide) braided stent with six‐arm poly(L‐lactide‐co‐ε‐caprolactone) coating cross‐linked by hexamethylene diisocyanate

“…The COF is defined as the force when the lumen is released to the indicated use diameters (IUD, 6 mm) during the expansion process. 26 Besides, the axial elongation rate is also an indicator to evaluate the stability of the stent, which is calculated by Equation ( 2):…”

“…The COF is defined as the force when the lumen is released to the indicated use diameters (IUD, 6 mm) during the expansion process 26 . Besides, the axial elongation rate is also an indicator to evaluate the stability of the stent, which is calculated by Equation (2): where L 0 is the initial length of the stent, L 1 is the length of the stent at a certain moment after the radial force test experiment.…”