Anaesthesia For Interventional Radiology

The speciality of interventional radiology is a new branch in the radiological field developed with the advances in catheter and instnlment technology, together with the development of appropriate radiological expertise and improvement in the image monitoring systems.The anaesthesiologists are increasingly called III the- ~interventional radiological suite to provide anaesthesia or manage the expected complications. So familiarity with the interventional ,radiological procedure is mandatory.Preprocedural assessment of the patient as well as having full data about the procedures performed are mandatory to evaluate the medical condition of the patient, determine the anaesthetic plane, predict the possible complications and prepare for their management.The preparation of the patient and the radiological laboratory is similar to that performed if the patient is going to surgical procedure, but problems associated with working environment like darkeness of the room, crowdedness and poor accessibility to the patient are encountered and must be dealt with.The anaesthesiologist can provide monitored anaesthesia care ”MAC” in patients managed with local anaesthesia or in consciouslysedated patients. General anaesthesia may be indicated in some situations. Regional anaesthesia is helpful for some procedures.The choice of anaesthetic plan depends on:1) The patient’s medical condition: which also determine the agents used during the selected anaesthetic plane such as being hepatic, renal or cardiac, also being adult or pediatric.2) The planned procedure: For example, minor procedures like percutaneous biopsy can be done under local anaesthesia but major procedures like pediatric cardiac catheterization is done under general anaesthesia.3) Expected complications: For example, if aspiration,haemodynamic instability or ventilatory failure are expected, general anaesthesia is required.Monitoring of the patient undergoing interventional radiological procedures vary from simple monitoring methods like palpation of pulse, observation of respiration and pulse oximetry in minor procedures up to the most sophisticated monitoring methods like invasive blood pressure, pulmonary capillary wedge pressure and intracranial pressure monitoring in major and complicated procedures.Specialized requirements are asked for by the radiologists during special procedures and need experience of the anaesthesiologist for manipulation of haemodynamics, ventilatory assistance and conscious level.- Deliberate hypo or hypertension- Deliberate hypercapnia- AnticoagulationContrast media reactions are specific problems encountered in the radiological practice so prophylaxis and management must take place.Life threatening events. can arise during the procedure like severe haemorrhage in TIPSS or fatal cardiac arrhythmias during cardiac catheterization. So the ’anaesthesiologist must have good experience about urgent management of these complications. Dnlgs and equipments necessary for management of these complications must be present. CPR measures must be available including defibrillator.Surgical interference may be needed for management of complicated course of the interventional radiological procedures as emergency CABG so the anaesthesiologist may participate for this surgical management.Post procedure, the patient is transported to the recovery area with full monitoring and resuscitation equipment until full recoveryfrom anaesthesia to be discharged to the ward and may be discharged on the second day. Same day discharge is reported.Patients having complications or undergoing prolonged procedures with massive haemodynamic manipulation are admitted to leU for haemodynamic stability or ventilatory support.Radiation exposure is considered hazardous for anaesthetic personnel so protective measures must be taken like wearing aprons or standing behind protective barriers.