Postępowanie anestezjologiczne podczas endowaskularnego leczenia niepękniętych tętniaków wewnątrzczaszkowych

Abstract

Endovascular techniques for treatment of intracranial aneurysms are increasingly commonly applied. In general, the procedures are short, require general anaesthesia and complete immobilisation of patients. The aim of the present study was to assess the usefulness of general anaesthesia with propofol and laryngeal mask airway for endovascular management of intracranial aneurysms based on analysis of haemodynamic stability. The study encompassed 26 patients undergoing endovascular treatment of intracranial aneurysms. The mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS), end-tidal CO₂(E(T)CO₂) and haemoglobin saturation with oxygen (SpO₂ ) were determined at eight measurement points: T₁ - before anaesthesia induction, T₂ - after induction, T₃ - after LMA insertion, T₄ - during arteriography, T₅ - during "coiling" , T₆ - at completion of propofol infusion, T₇ - before LMA removal, T₈ - after LMA removal. MAP and HR were found significantly reduced between T₂ and T₁ . To maintain BIS within the range of 40-60, the following propofol infusion rates (in mg kg b.w.⁻¹ h⁻¹ ) were required: T₂ - 4.5 ± 0.3; T₃ - 4.6 ± 0.7; T₄ - 4.5 ± 0.8 and T₅ - 4.4 ± 0.6. E T CO₂ and SpO₂ were not demonstrated to be changed. The mean duration of anaesthesia and of recovery was 64.3 ± 21.8 and 8.9 ± 4.8 min, respectively. General anaesthesia with propofol and LMA ensures suitable conditions for endovascular treatment of intracranial aneurysms.