[Protocol for preparation, anesthesia and monitoring in therapeutic angiography]

The procedures involved in cerebral and medullary embolization produce special problems for the anesthesiologist. Some imperatives must be followed in order to minimize the high neuroradiological risks associated with these long and repetitive procedures. The first of these imperatives is sedation, which throughout the procedure should be sufficient, although not narcotic enough to prevent neurological evaluations. The use of a benzodiazepine (Midazolam) in conjunction with an analgesic (Alfentanil) that is rapidly eliminated answers this need. The prescription of vasodilatator agents depends on the location of the embolization. Calcium channel blockers should be used following embolism of the internal carotid while nitrate derivatives are recommended after embolism of the external carotid. Reduction of the risk of thrombosis is accomplished by perfusion with anti-sludge or, with exception to therapeutic procedures involving hemostasis, by perfusion with acetylsalicylic acid. Following evaluation of 105 procedures in 75 patients it is concluded that this sedation produces reliable results and allows the procedure to be performed with maximal security.