Anesthesia Student Survival Guide.pdf - Index of

392 ● AnesthesiA student survivAl Guide
the vessel(s) of interest. Generally speaking, neuroradiology procedures are
minimally painful except for the vascular access of the femoral artery in the
groin, which can be performed under local anesthesia. However, the procedures
involve highly sensitive areas and the anesthesia team must anticipate
the need for rapid conversion to general anesthesia (e.g. in case of aneurysm
rupture, embolization of critical feeding vessel).
General endotracheal anesthesia is preferred for nondiagnostic embolization
and coiling procedures. These procedures require absolute field quiescence
and have a higher risk of deleterious side effects or complications.
Choice of induction and maintenance strategy should be catered to the specific
patient and the pathophysiology under management. Usually, an amnestic dose
of inhaled potent agent with maintenance of muscle relaxation is appropriate.
Blood pressure should be maintained in an appropriate range as determined
by preoperative factors (elevated intracranial pressures, evolving stroke, status
of the aneurysm, and baseline hypertension) and after discussion with neurology
team. Nicardipine, labetalol, and phenylephrine are all suitable vasoactive
agents. Manipulation of the carotid artery (stenting/balloon angioplasty) may
activate baroreceptor reflexes that could produce rapid changes in blood
pressure or heart rate.
Kyphoplasty is a procedure that may be performed with general anesthesia
or sedation with the recognition that patient’s prone position is likely to be
uncomfortable, and the procedure itself can be quite painful.
Case Study
A 20-year-old woman is scheduled for breast augmentation surgery. She
attends college and works part time as a waitress, and works in the college
library. She is strongly motivated to have the procedure performed as an
outpatient and to return to work and minimize her time away from school
and work. She is generally healthy, though she notes that she has seasonal
allergies and occasional wheezing for which she takes an antihistamine
and uses a metered dose inhaler (albuterol) as needed. She does not smoke,
drinks alcohol on the weekends (3–4 drinks once per week), and does not use
recreational drugs. She takes oral contraceptives and also has a history of
motion sickness.