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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2017 May 11

DOI: 10.23736/S0375-9393.17.11753-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Italian COnsensus in Neuroradiological Anaesthesia (ICONA): managing anaesthesia during endovascular procedures

Carlo A. CASTIONI 1 , Andrea AMADORI 2, Federico BILOTTA 3, Moreno BOLZON 4, Edoardo BARBONI 5, Anselmo CARICATO 6, Guido DALL'ACQUA 7, Francesco DI PAOLA 7, Andrea FORASTIERI MOLINARI 8, Paolo GRITTI 9, Italia LA ROSA 3, Marcello LONGO 10, Carla MAGLIONE 11, Pietro MARTORANO 12, Marina MUNARI 13, Valerio PEROTTI 14, Frank RASULO 15, Maria RUGGIERO 16, Antonio SANTORO 3, Luigia SCUDELLER 17, Miriam TUMOLO 18, Anna T. MAZZEO 19, on behalf of the SIAARTI Study Group on Neuroanesthesia and Neuroresuscitation, AINR, SARNePI, SINCh 

1 Anesthesia and Critical Care Medicine 2, San Giovanni Bosco Hospital, Turin, Italy; 2 Neuro-Anesthesiology and Intensive Care Unit, CTO Careggi University Hospital, Florence, Italy; 3 Department of Anesthesiology, Critical Care and Pain Medicine, "Sapienza" University of Rome, Rome, Italy; 4 Neuroscience Department, Neuro-Intensive Care Unit and Neuro-Anesthesiology, Niguarda Hospital, Milan, Italy; 5 Neuroscience Department, Anesthesia and Intensive Care Section, Polytechnic University of Marche, Ancona, Italy; 6 Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, "A. Gemelli" Teaching Hospital, Intensive Care Unit, Rome, Italy; 7 Clinical Radiology, UOC di Neuroradiologia, Azienda ULSS 9 Treviso, Treviso, Italy; 8 Emergency Department, Anesthesiology and Intensive Care Medicine, Intensive Care Unit, A. Manzoni Hospital, Lecco, Italy; 9 Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; 10 UOC Neuroradiologia, Azienda Ospedaliera Universitaria Policlinico "G. Martino", Messina, Italy; 11 Department of Anesthesia, Postoperative Intensive Care, Burn Center and Hyperbaric Center, Antonio Cardarelli Hospital, Naples, Italy; 12 Neuro-Anesthesia Unit, Emergency Department, Azienda Hospital- Polytechnic University of Marche,“Ospedali Riuniti” Ancona, Italy; 13 Neuro-Intensive Care Unit and Neuro-Anesthesiology , Department of Anesthesia and Intensive Care Medicine, Azienda Hospital of Padova, University of Padua, Padua, Italy; 14 Anesthesia in Speciality Surgeries Section, Department of Emergency and Internal Medicine, Policlinico Universitario Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy; 15 Department of Anesthesia, Critical Care and Emergency Medicine, Spedali Civili University Hospital, Brescia, Italy; 16 Department of Neuroradiology, AUSL Romagna, Cesena, Italy; 17 Clinical Epidemiology Unit, Scientific Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; 18 Department of Anaesthesia and Intensive Care, Giannina Gaslini Children's Hospital, Genoa, Italy; 19 Anesthesia and Intensive Care Unit, Department of Surgical Sciences, University of Turin, Turin, Italy


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Anaesthetic management of patients undergoing endovascular procedures for treating intracranial aneurysms or cerebrovascular malformations must consider a number of specific challenges, in addition to those associated with anaesthesia for other specialties. In addition to maintenance of physiological stability, manipulation of systemic and cerebral haemodynamic parameters may be required to treat any sudden unexpected catastrophic neurological events. A multidisciplinary group including neuro- and pediatric anaesthesiologists, interventional neuroradiologists, neurosurgeons, and a clinical methodologist contributed to this document. This consensus working group from 21 Italian institutions identified open questions regarding the best practices for management of anaesthesia during endovascular neuroradiological procedures for intracranial aneurysms and cerebrovascular malformations, and addressed these by formulating practical consensus statements. At the first meeting in November 2015, nine key areas were identified regarding choice of anaesthetic, patient monitoring, haemodynamic targets, postoperative care, and the management of neuromuscular blockade, anticoagulant and/or antiplatelet therapy, and special considerations for paediatric patients. Nine subgroups were established and a medical librarian performed literature searches in the Cochrane and MEDLINE/PubMed databases for each group. Groups drafted literature summaries and provisional responses in the form of candidate consensus statements based on evidence, when possible, and clinical experience, when this was lacking. Final wording was agreed at a meeting in April 2016 and where possible evidence was graded using United States Preventive Services Task Force criteria. Consensus (defined as >90% agreement) was based on evidence, clinical experience, clinician preference, feasibility in the Italian healthcare system, and cost/benefit considerations.


KEY WORDS: Intracranial aneurysm - Cerebrovascular malformation - Endovascular treatment - Anaesthesia -
Neuroradiology - Interdisciplinary consensus

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Cite this article as

the SIAARTI Study Group on Neuroanesthesia and Neuroresuscitation, AINR, SARNePI, SINCh

Corresponding author e-mail

carloalbertocastioni@gmail.com