Background: There is still no consensus about the best anesthesia strategy for interventional neuroradiology. Choice between general anesthesia (GA) and conscious sedation (CS) remains in the hands of (neuro)anesthesiologist.
Clinical case-series: Over the last four years our neurointerventional center in Croatia continuously has grown and developed from low to high-volume. We present single center experience with more than one hundred procedures every year. During the last year there were 60 thrombectomies and 60 other cases. General endotracheal anesthesia is preferred method that we use, with target controlled infusion (TCI) technique with propofol and remifentanil, and rocuronium for intubation. Low dose of esmolol is used for smooth intubation (avoiding BP and ICP increase). Short acting drugs allows rapid neurological examination after procedure. Using this strategy, we avoid BP variability, movements are decreased, patient’s airway is secured and optimal control of carbon dioxide levels are achieved. Monitoring includes: ECG, invasive and non-invasive BP, SpO2, RR, EtCO2, BIS and hourly urinary output.
Discussion: In anesthetic management exists large variability so interventional neuroradiology is challenging for anesthesiologist. Anesthetic management for this patients is much more than anesthetic plan of sedation or GA. Strategies include an individualized approach to hemodynamic and respiratory parameters, intravascular fluids, coagulation control and neuroprotection that can be essential for a favorable outcome. “Time is brain” and dedicated team members are time saving. Taking into account patients, technical and clinical factors we found GA the most suitable for our patients.
 Learning points: Crucial steps in establishment of interventional neuroradiology is creation of a competent neuroanaesthesiologist, who are able to provide care for this patients. Drugs fine titration, accurate BP and respiratory function monitoring, good plan in dealing with possible complication and close collaboration with neuroradiologist are milestones of favourable outcome. In view of that, anaesthesiologist’s contribution to this procedure is essential and the best anesthesia management is in partnership with the neuroradiologist.



05 / Interventional neuroradiology- the specific challenges for anesthesiologist