Difference between revisions of "Cerebral angiogram"

From WikiAnesthesia
(Summary of cerebral angiogram)
(Preop section complete)
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| monitors = Standard
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| considerations_preoperative =  
| considerations_intraoperative = Normotension if aneurysm
| considerations_intraoperative = Maintain normotension if aneurysm
| considerations_postoperative =  
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=== Indications ===
=== Indications ===
It can be used to further investigate AV malformations, aneurysms, blood flow to tumor, or other abnormal arterial blood flow.
It can be used to further investigate cerebral hemorrhage, AV malformations, cerebral aneurysms, blood flow to tumor, or other abnormal arterial blood flow.


=== Surgical procedure ===
=== Surgical procedure ===
The most common approach is through the femoral artery, though occasionally it can be done through the radial artery (e.g. if patient has history of femoral bypass procedure). Upon access the artery through catheter, contrast is injected with timed X-ray imaging.
The most common approach is through the femoral artery, though occasionally it can be done through the radial artery (e.g. if patient has history of femoral bypass procedure). Upon access the artery through catheter, contrast is injected with timed X-ray imaging.
=== Type of anesthesia ===
This procedure can be done without anesthesia or with MAC anesthesia for most patients who are able to follow commands and lie still, and if the the procedure is purely diagnostic in nature. If a patient is unable to lie still, or will need additional treatment (e.g. embolization, stent placement, etc.), then general anesthesia is used.


== Preoperative management ==
== Preoperative management ==
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|-
|-
|Neurologic
|Neurologic
|
|Depending on the abnormality being explored, patients may have baseline neuro deficits which should be known preoperatively
|-
|-
|Cardiovascular
|Cardiovascular
|
|Patients with aneurysms and history of hypertension should continue antihypertensives to avoid sheer stress
|-
|-
|Pulmonary
|Pulmonary
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=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
Coags, BMP (to evaluate kidney function prior to high volume contrast)


=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
In general, multiple C arms in different planes are used, so the anesthesia machine and monitors are situated far from patient. Multiple extensions are needed for any lines (PIVs, arterial lines, central lines) and long cables for monitors.
For patients with tight blood pressure control required (e.g. cerebral hemorrhage, aneurysm), prepare multiple antihypertensives (nicardipine infusion, nitroglyceride injection) and vasopressors (norepinephrine infusion, phenylephrine injection).


=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
If there is high concern for neurologic deficit, medications that may alter mental status exam postoperatively should be used with caution: e.g. midazolam, scopolamine patch.


=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===
N/A


== Intraoperative management ==
== Intraoperative management ==

Revision as of 14:35, 20 June 2022

Cerebral angiogram
Anesthesia type

General vs MAC vs no anesthesia

Airway

ETT vs natural airway

Lines and access

1 PIV

Monitors

Standard

Primary anesthetic considerations
Preoperative
Intraoperative

Maintain normotension if aneurysm

Postoperative
Article quality
Editor rating
In development
User likes
1

A cerebral angiogram (also known as cerebral arteriogram) is a procedure where contrast is injected through an artery and X-Rays are used to visualize the cerebral blood flow. It is performed by neuro-interventional radiology.

Overview

Indications

It can be used to further investigate cerebral hemorrhage, AV malformations, cerebral aneurysms, blood flow to tumor, or other abnormal arterial blood flow.

Surgical procedure

The most common approach is through the femoral artery, though occasionally it can be done through the radial artery (e.g. if patient has history of femoral bypass procedure). Upon access the artery through catheter, contrast is injected with timed X-ray imaging.

Type of anesthesia

This procedure can be done without anesthesia or with MAC anesthesia for most patients who are able to follow commands and lie still, and if the the procedure is purely diagnostic in nature. If a patient is unable to lie still, or will need additional treatment (e.g. embolization, stent placement, etc.), then general anesthesia is used.

Preoperative management

Patient evaluation

System Considerations
Airway
Neurologic Depending on the abnormality being explored, patients may have baseline neuro deficits which should be known preoperatively
Cardiovascular Patients with aneurysms and history of hypertension should continue antihypertensives to avoid sheer stress
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Coags, BMP (to evaluate kidney function prior to high volume contrast)

Operating room setup

In general, multiple C arms in different planes are used, so the anesthesia machine and monitors are situated far from patient. Multiple extensions are needed for any lines (PIVs, arterial lines, central lines) and long cables for monitors.

For patients with tight blood pressure control required (e.g. cerebral hemorrhage, aneurysm), prepare multiple antihypertensives (nicardipine infusion, nitroglyceride injection) and vasopressors (norepinephrine infusion, phenylephrine injection).

Patient preparation and premedication

If there is high concern for neurologic deficit, medications that may alter mental status exam postoperatively should be used with caution: e.g. midazolam, scopolamine patch.

Regional and neuraxial techniques

N/A

Intraoperative management

Monitoring and access

Induction and airway management

Positioning

Maintenance and surgical considerations

Emergence

Postoperative management

Disposition

Pain management

Potential complications

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References