Rocuronium bolus 1 mg.Kg -1 followed by continuous perfusion (0.1 mg.Kg -1.h -1) was administered to maintain one response of a train-of-four (S/5 Datex Ohmeda®, Helsinki, Finlandia). Intravenous anesthesia was administered through a target-controlled infusion system (Orchestra Infusion Workstation, Primea Base Fresenius Vial, Bad Homburg v.d.H., Germany) with propofol (target concentration, 4–6 µg.mL -1) and remifentanil (target, 2–4 ηg.mL -1) adjusted to keep the bispectral index close to 50. All procedures were performed under general anesthesia. Each patient was preoxygenated (100% oxygen) through a face mask. Our institutional protocol included premedication with 5 mg of oral diazepam the night before and 2 hours before surgery, continuation of corticosteroids or anticonvulsants throughout the procedure and antibiotic prophylaxis (intravenous ceftriaxone, 2 g).Ĭontinuous monitoring consisted of blood pressure (arterial cannulation or use of a noninvasive monitor ), electrocardiogram, and the Bispectral Index monitoring (BIS, Brain Monitoring System Covidien, Mansfield, MA, USA), pulse oximetry (S/5 Datex Ohmeda, Helsinki, Finland) and bilateral regional Oxygen Saturation (SrO 2) (INVOS 5100C Cerebral/Somatic Oximeter, Minneapolis, MN, USA). 7, 8 We present the analysis of our 9-year experience with using SGD as an alternative to assess the feasibility of this approach to airway management in patients undergoing endovascular treatment in UIAs. ![]() Only a few case series, including a limited number of patients, have reported the feasibility of SGD during endovascular treatment of UIAs. ![]() 4, 5, 6 Nevertheless, there is concern that SGD may not provide the same degree of airway protection and safety as OTI during these long procedures. Furthermore, OTI is also associated with more coughing episodes and potentially deleterious hemodynamic changes during emergence compared to Supraglottic Devices (SGD), which have less impact in the sympathetic nervous system. However, OTI is associated with hemodynamic effects that may increase the risk of aneurysm rupture prior to occlusion. 1, 2, 3 The standard of care calls for general anesthesia with Orotracheal Intubation (OTI), muscle paralysis, controlled ventilation, and standard monitoring plus invasive arterial pressure recording to provide absolute immobility and strict hemodynamic control. The efficacy of endovascular intracranial aneurysm treatment has been recognized since the 1970s, and although its safety has been demonstrated in Unruptured Intracranial Aneurysms (UIAs), little has been published about perioperative anesthetic care in this setting. A post-hoc analysis showed that orotracheal intubation was used in 55 patients (44%) in 2010 through 2014 and 2 (3.2%) in 2015 through 2018, parallel to a trend toward less invasive blood pressure monitoring from the earlier to the later period from 34 (27.2%) cases to 5 (8.2%). Two in each group also had intraoperative bleeding. ![]() Two patients in each group died during early postoperative recovery. Thirty-three of them (73.3%) required orotracheal intubation compared to 24 of the 142 (16.9%) with non-complex aneurysms. Forty-five patients (24.1%) had complex aneurysms or a history of subarachnoid hemorrhage. Three orotracheal intubation patients had a bronchospasm or laryngospasm during awakening. Three supraglottic device patients required supraglottic device repositioning and 1 supraglottic device patient required orotracheal intubation due to inadequate ventilation. No adverse incidents were recorded in 97% of the cases. We included 187 patients in two groups: supraglottic device 130 (69.5%) and orotracheal intubation 57 (30.5%).
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