Cooperative Patient General Anesthesia (Co.Pa.Ge.A.): The New Anesthetic Technique for Neurological Monitoring of the “Cooperative” Patient During Endovascular Treatment of Elective Brain Arteriovenous Malformations With Onyx18

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An anesthetic technique, which allows for neurological monitoring as well as continuous and safe monitoring of the airways with orotracheal intubation (cooperative patient general anesthesia [Co.Pa.Ge.A.]) has been described in patients undergoing elective thromboendoarterectomy surgery. The aim of this paper is to evaluate the effectiveness and the safety of Co.Pa.Ge.A. during scheduled endovascular treatments of brain arteriovenous malformations with a polymeric embolization agent, Onyx18.


Ten patients (3 F, 7 M; median age: 33.5±6.0 y, range: 20 to 39 y, American Society of Anesthesiologists class I to II) underwent endovascular embolization of brain arteriovenous malformations located in an eloquent area. Remifentanil was administered IV until an anesthetic target level was reached which allowed the anesthesiologists and the neuroradiologists to perform neurological monitoring during the entire procedure. The degree of patient satisfaction was evaluated based on a questionnaire administered the day after the procedure.


Co.Pa.Ge.A. was successfully performed on all of the patients. No intraprocedural or postprocedural adverse events occurred. Hemodynamic stability was maintained in 5 cases with Remifentanil alone, in 2 cases with Remifentanil and Clonidine and in 1 case with Remifentanil and Nimodipine.


At the moment and to the best of our knowledge, this is the first report in the medical literature on this new anesthetic technique in interventional neuroradiology. Co.Pa.Ge.A. can be considered a safe, effective, and satisfactory technique characterized by hemodynamic stability and good control of the respiratory pattern, offering the possibility to perform real-time neurological monitoring and easy conversion to general anesthesia in case of intraprocedural complications or anesthetic necessity.

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