The general goals of anaesthetic management during endovascular procedure involve haemodynamic control to minimise the risk of aneurysm re-rupture, to protect the brain against ischaemic injury and to keep the patient motionless to optimise the quality of the images used to perform the endovascular procedure: hence, general anaesthesia with endotracheal intubation is often preferred for these procedures at most centres. But general anaesthesia is not available in all hospital and in all situations. At the authors’ institution, coil embolisation of the intracranial aneurysm is performed under monitored anaesthesia using dexmedetomidine. To determine the feasibility and safety of this approach, the author has reviewed our clinical experience.Methods
Retrospectively analysis of prospectively collected data at single neurovascular institution was performed during July 2012 to November 2012. We performed more than 50cases using this method. In these cases, we analysed 12cases, their procedure time is more than 1hour for statistical significance.Methods
To measure the haemodynamic and respiratory impact of the drug to the patients, vital signs of the patients were checked every 10 minutes throughout the procedures. Systolic blood pressure (sBP), diastolic blood pressure (dBP), mean arterial blood pressure (mABP), heart rate (HR), respiratory rate (RR) and peripheral oxygen saturation (SpO2) were recorded at each time point as follow; preoperative baseline, at anaesthesia start, after every 10 minute until the end of procedures. Depth of sedation was measured by Ramsay sedation scale and frequency of the repeated roadmap caused by the patient head movement during the endovascular procedure.Results
All procedures were completed without procedure related complications. Obliteration of the intracranial aneurysm was performed in all cases. With dexmedetomidine induced monitored anaesthesia, vital signs (sBP, dBP, and mABP, HH, RR and SpO2) of the patients were not changed during the procedure. Haemodynamic and respiratory parameters did not showed any statistical significance (P value > 0.05). Adequate sedation for endovascular procedure was achieved. Mean Ramsay sedation scale was 3.67 ± 1.61 (2 to 6). Repeated roadmap due to patient’s factor was occurred in only one case. The drug dose for adequate sedation for endovascular procedure was 0.65 ± 0.12 mcg/kg/hr without loading doses.Conclusion
Embolisation of the intracranial aneurysms with dexmedetomidine anaesthesia appeared to be safe and feasible. Differently with other drugs, there was no systemic side effects such as hypotensio, bradycardia and respiratory depressions. In you need endovascular surgery for intracranial aneurysm; general anaesthesia is the first choice to be selected. But local anaesthesia with dexmedetomidine should be considered as alternative, when it is not suitable .Disclosures
C. Chang: None. Y. Jung: None. B. Choi: None.