Anaesthetic Considerations for Neuro-Endovascular Procedures: A Narrative Review

Abstract

The spectrum of neurological conditions amenable to endovascular treatment has increased over the last several years and increased the volumes of patients anesthetized outside the operating room. Anaesthetic management of patients undergoing neuro-endovascular procedures pose several challenges such as emergent nature of interventions, significant co-morbid conditions, not adequately optimized neurological status, and concerns and considerations associated with providing anaesthesia services at remote locations. In this review, general aspects of care of patients undergoing neuro-endovascular procedures are detailed at the beginning such as pre-anaesthetic evaluation, radiation concerns, challenges with providing anaesthesia at remote locations and anaesthetic techniques commonly used which includes monitored anaesthesia care, procedural sedation and general anaesthesia. This is followed by discussion on management of individual neurological pathologies, common procedural complications and their management, and post-procedural care.