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Minerva Anestesiologica 2017 September;83(9):956-71

DOI: 10.23736/S0375-9393.17.11753-0


lingua: Inglese

Italian COnsensus in Neuroradiological Anesthesia (ICONA)

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 Neuro-Intensive and Neuro-Anesthesiology Care Unit, Department of Neuroscience, Niguarda Hospital, Milan, Italy; 5 Department of Neuroscience, Anesthesia and Intensive Care Unit, University of Marche, Ancona, Italy; 6 Intensive Care Unit, Department of Anesthesiology and Intensive Care Medicine, “A. Gemelli” Teaching Hospital, Sacro Cuore Catholic University, Rome, Italy; 7 Unit of Neuroradiology, Department of Clinical Radiology, 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 Anesthesia and Intensive Care, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; 10 Unit of Neuroradiology, “G. Martino” University Hospital, Messina, Italy; 11 Postoperative Intensive Care Unit, Department of Anesthesia, Burn Center and Hyperbaric Center, Antonio Cardarelli Hospital, Naples, Italy; 12 Unit of Neuro-Anesthesia, Emergency Department, “Ospedali Riuniti” Marche University Hospital, Ancona, Italy; 13 Unit of Neuro-Intensive and Neuro-Anesthesiology Care, Department of Anesthesia and Intensive Care Medicine, Padua University Hospital, University of Padua, Padua, Italy; 14 Section of Anesthesia in Speciality Surgeries, Department of Emergency and Internal Medicine, Policlinico Universitario Agostino Gemelli, Sacro Cuore Catholic University, 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, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; 18 Department of Anaesthesia and Intensive Care, Giannina Gaslini Children’s Hospital, Genoa, Italy; 19 Unit of Anesthesia and Intensive Care, Department of Surgical Sciences, University of Turin, Turin, Italy


Anesthetic 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 anesthesia for other specialties. In addition to maintenance of physiological stability, manipulation of systemic and cerebral hemodynamic parameters may be required to treat any sudden unexpected catastrophic neurological events. A multidisciplinary group including neuro- and pediatric anesthesiologists, 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 anesthesia 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 anesthetic, patient monitoring, hemodynamic targets, postoperative care, and the management of neuromuscular blockade, anticoagulant and/or antiplatelet therapy, and special considerations for pediatric 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 - Endovascular procedures - Anesthesia - Neuroradiology

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