Aneurysm Coiling

 

 

Considerations

 

  • Unfamiliar/remote environment:

    • Limited help & specialized tools

    • Potential prolonged patient transfers

  • Limited access to patient

  • Need for absolute immobility (muscle relaxant or remifentanil infusion) 

  • Unsecured aneurysm:

    • Risk of rupture: need to avoid ↑ transmural pressure

    • Need to control hemodynamics: possible need for hypotension or sinus pause for coil placement

      • place external pacing/defibrillator pads 

  • Complications:

    • Aneurysmal perforation/rupture

    • Cerebral ischemia due to misplaced coils, clots, vasospasm, dissection

    • Seizures 

    • Contrast (anaphylactoid reactions, contrast-induced nephropathy, acute kidney injury)

 

 

Anesthetic Technique 

 

  • Pre-induction arterial line is necessary 

  • Maintain cerebral perfusion pressure (CPP) to prevent ischemia, but avoid ↑ transmural pressure to prevent aneurysm rupture 

  • Maintain on sevoflurane & remifentanil OR propofol & remifentanil

  • Usually heparinized to ACT 2-3X normal