Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Anesthesiology, University of Illinois at Chicago, Chicago, Illinois, USA.
Curr Opin Anaesthesiol. 2022 Aug 1;35(4):457-464. doi: 10.1097/ACO.0000000000001151. Epub 2022 Jul 5.
The 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.
Various 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.
Combining different anesthetic modalities is a valuable approach in the neurointerventional radiology suite. More interventional and patient population-specific studies are needed to improve evidence-based perioperative management.
神经介入医师所进行的手术范围迅速扩大，但对于最佳麻醉方式尚未达成共识。尽管这些手术涉及所有年龄段，但介入可能很复杂且耗时较长，并且可能在目前不熟悉该领域的医院进行。在此，我们回顾了目前关于选择性门诊神经介入手术的文献，旨在提供介入相关危象管理的最新信息，探讨特殊患者群体，并为神经介入放射学手术室的日常工作提供关键学习要点。
多项研究比较了不同麻醉方式和介入前及介入后的护理。对于老年患者，一般建议使用监测麻醉护理，而儿童则最好采用全身麻醉。对于经皮椎体后凸成形术和血管入路等手术，额外使用局部麻醉有益。
在神经介入放射学手术室中，结合使用不同的麻醉方式是一种有价值的方法。需要更多针对介入和患者人群的研究来改善基于证据的围手术期管理。
