This is the Cat 1 section of neuroradiology: every minute hundreds of thousands of neurons die. There needs to be meticulous maintenance of blood pressure. You will be in an unfamiliar environment- one of the IR theatres. GA is favoured here as there is a higher chance of clot retrieval and therefore better functional outcome.
Pre-op
- History gathered from multiple places (neuroradiologists, stroke team etc)
- Location of stroke
- Fasting status
Peri-op
- RSI if indicated- likely
- Metaraminol infusion
- Aim MAP 70-90 – confirm with neuroradiologist
- Remifentanil TCI
- Propofol – small dose
- Rocuronium
- ETT
- Sevoflurane maintenance
- Arterial line after induction, whilst groin being prepped
Post-op
- Aim for as rapid wake up as possible
- This is not a painful procedure- just a groin puncture for access
- Agree BP target with neuroradiologist and stroke team- 140-180mmHg superior to <120mmHg in patients with raised systolic BP (≥140mmHg) after reperfusion – ENCHANTED2 trial
Alternatives
- Propofol/ remifentanil TIVA
Anaesthetic Recipes 