Trans-catheter embolization via wrist
- Access
- PIV x1-2, PRE(or post)-induction arterial line (exquisite BP control, do not want to go hypertensive and rupture the aneurysm) (Akano cutoff is if > 5 mm aneurysm, pre-induction arterial line)
- Airway
- Oral ETT
- Induction
- Standard
- Maintenance
- Gas and paralytic
- Antibiotics
- Cefazolin
- Emergence
- Awake
- Position
- 180
TIVA may also be used for a smooth wakeup. Arguably, gas increases ICP (which Akano argues may provide tamponade effect on aneurysm).
TIVA (propofol/remifentanil/nicardipine (+/-)/phenylephrine) and paralytic (sometimes deep paralysis to avoid movement). Remifentanil may still be useful for additional immobility if paralysis lapses and for sympathetic blunting.
Notes
Avoid the C-arm. Watch lines. PIV on left (access by surgery on right). Pulse ox on RIGHT hand (where surgeons access).
Heparin on surgeon access on surgeon request.
Goal SBP < 160.