• Interventional neuro
    • Procedures
      • Diagnostic
        • CT
        • MRI
        • Angiography
      • Therapeutic
        • Embolization
          • Cerebral aneurysm
          • AVM
        • Stereotactic surgery
        • Sclerotherapy
        • Balloon angioplasty
        • Thrombolysis
    • Pre-op assessment
      • Neurology & assessment
      • CVS - Catecholamine release
      • Respiratory system
      • Metabolic considerations
    • Special considerations
      • Unfamiliar environment, dim lights, unfamiliar staff, isolated from help
      • Transfer between CT/MRI/ITU
      • Radiation
      • Radiology equipment moving etc
      • Closed skull
      • Contrast and flush
      • Use of antiplatelets
      • Sedation, repeated neurological evaluation
      • Image degradation
    • Anaesthesia for aneurysms
      • Premed on individual basis
      • Monitoring and equipment
      • Catheterise
      • Avoid venous obstruction
      • Arterial line
      • Consider CVP
      • Good vascular access
      • Induction
        • Propofol + opiate
        • IV lignocaine or β-blockers
      • Maintenance
        • Volatiles or TIVA
        • Avoid nitrous
        • Remifentanil
        • Mild hypocapnoea
        • ACT 2-3x normal (5000u heparin)
        • Temp control
      • Recovery
        • Rapid, smooth
        • Unsecured aneurysms may necessitate hypotension at extubation
      • Complications
        • Haemorrhagic
          • Intubation
          • Vasoactive drugs
          • Coiling procedure
        • Occlusive
          • Wires
          • Coil misplacement
          • Dissection
          • Vasospasm
            • HHH, Hct 30%, CVP 8-12mmHg
    • CEACCP
      Link:ceaccp.oxfordjournals.org/content/8/3/86.full.pdf