Anaesthetic management for endovascular treatment of unruptured intracranial aneurysms

Background. 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. Material and methods. 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 (SpO(2)) were determined at eight measurement points: T-1 - before anaesthesia induction, T-2 - after induction, T-3 - after LMA insertion, T-4 - during arteriography, T-5 - during coiling, T-6 - at completion of propofol infusion, T-7 - before LMA removal, T-8 - after LMA removal. Results. MAP and HR were found significantly reduced between T-2 and T-1. To maintain BIS within the range of 40-60, the following propofol infusion rates (in mg kg b.w.(-1) h(-1)) were required: T-2 - 4.5 +/- 0.3; T-3 - 4.6 +/- 0.7; T-4 - 4.5 +/- 0.8 and T-5 - 4.4 +/- 0.6. ETCO2 and SpO(2) 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. Conclusions. General anaesthesia with propofol and LMA ensures suitable conditions for endovascular treatment of intracranial aneurysms.