[Anesthesia in interventional neuroradiology]. / Anestesia en neurorradiología intervencionista.

Interventional neuroradiology procedures have become increasingly complex, requiring planning and coordination. Key roles are played by the anesthesiologist and the radiologist, as well as by technicians and nurses. This review aims to analyze the anesthesiologist's part in managing these procedures, from the start of the intervention through the immediate postoperative period. First concerns are to assure patient safety during transfer, maintain the airway, keep the patient immobile and hemodynamically stable, and manage anticoagulant and antiplatelet treatments. Rapid awakening must also be assured so that the patient's neurologic status can be assessed in situ. The anesthesiologist should treat any neurologic complications that develop and that might lead to emergency situations during the procedures.

Anestesia en neurorradiología intervencionista / Anesthesia in interventional neuroradiology

Los procedimientos que se realizan en neurorradiologíaintervencionista son cada vez más complejos por loque deben estar bien planificados y coordinados. Elanestesiólogo junto con el radiólogo, técnicos y enfermerasjuega un papel fundamental. Con esta revisión sepretende analizar el papel del anestesiólogo en estos procedimientosdesde el inicio hasta su manejo en el postoperatorioinmediato. En primer lugar debe garantizar laseguridad en el transporte, mantener la vía aérea, conseguirla inmovilidad del paciente, controlar la estabilidadhemodinámica, manejar la anticoagulación y la antiagregacióny asegurar un despertar rápido para valorarneurológicamente al paciente in situ. Así mismo, deberátratar las posibles complicaciones cerebrales durante losprocedimientos que pueden llegar a ser emergencias (AU)

Interventional neuroradiology procedures havebecome increasingly complex, requiring planning andcoordination. Key roles are played by the anesthesiologistand the radiologist, as well as by technicians and nurses.This review aims to analyze the anesthesiologist’s part inmanaging these procedures, from the start of theintervention through the immediate postoperativeperiod. First concerns are to assure patient safety duringtransfer, maintain the airway, keep the patient immobileand hemodynamically stable, and manage anticoagulantand antiplatelet treatments. Rapid awakening must alsobe assured so that the patient’s neurologic status can beassessed in situ. The anesthesiologist should treat anyneurologic complications that develop and that mightlead to emergency situations during the procedures (AU)

[Anesthesia in surgery for epilepsy]. / Anestesia en la cirugía de la epilepsia.

OBJECTIVES: To evaluate the efficacy of general anesthesia during epileptic surgery. MATERIAL AND METHODS: A retrospective study of 64 patients who received general anesthesia during epileptic surgery. In the preoperative period, anticonvulsive medication was adjusted in accordance with plasma levels and withdrawn entirely 8 hours before surgery. After premedication with droperidol and fentanyl, a balanced anesthetic technique was applied, based on pentothal, pancuronium (or vecuronium), fentanyl, N2O and isoflurane. Continuous monitoring of ECG, arterial blood pressure, pulse oximetry, ET CO2 and neuromuscular function. Isoflurane was stopped for 10 min after the opening of the duramadre so that ECoG could be recorded and methohexital or propofol was given in some cases in order to activate the epileptogenic focus. Muscular relaxation was restored intraoperatively following the study of somatosensory evoked potentials. Immediate and later complications related to anesthesia or surgery were recorded. RESULTS: The surgical procedure performed in most cases was temporal or frontal resection, with a mean duration for anesthesia of 377 +/- 50 min and for surgery of 318 +/- 50 min. Only one patient received local anesthesia and no hemodynamic changes were observed. Perioperative complications were cerebral edema (4 cases), arrhythmia (2 cases) and bronchospasm (1 case). Postoperative complications were as follows: 3 of 9 patients undergoing callosotomy required mechanical ventilation for 24 hours, 4 patients experienced language alterations, 3 wounds were infected, 2 cases of hemiplegia were observed, 1 status epilepticus occurred after administration of propofol and there was 1 case of respiratory distress. Anticonvulsive medication was given parenterally after surgery. CONCLUSIONS: General anesthesia is a safe and effective method for epileptic surgery, with local anesthesia providing additional sedation for isolated cases. Appropriate treatment requires an understanding of the pharmacokinetics and pharmacodynamics of the drugs used, as well as knowledge of the condition and the anticonvulsive medications used.