Difference between revisions of "Cerebral angiogram"
(Summary of cerebral angiogram) |
(Preop section complete) |
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| monitors = Standard | | monitors = Standard | ||
| considerations_preoperative = | | considerations_preoperative = | ||
| considerations_intraoperative = | | considerations_intraoperative = Maintain normotension if aneurysm | ||
| considerations_postoperative = | | 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 == | ||
| Line 31: | Line 34: | ||
|- | |- | ||
|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 | ||
| Line 56: | Line 59: | ||
=== 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
| 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 | |
| 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
Top contributors: Tony Wang