Anaesthesia for closed embolisation of cerebral arteriovenous malformations

Cerebral arteriovenous malformation embolisation is a therapeutic, neuroradiological procedure involving injection of bucrylate glue into the nidus of the AV malformation to obliterate the abnormal vascular network. These procedures may involve significant risks, are often long and thereby necessitate the need for some form of sedation and for adequate monitoring of the cerebral, cardiovascular and respiratory systems. The anaesthetic management of a series of twenty patients undergoing embolisation of a cerebral arteriovenous malformation is outlined, seven general and nineteen neurolept anaesthetics being administered. Neurolept anaesthesia is the preferred technique as neurological assessment during the procedure is possible and complications may be diagnosed immediately. Systemic arterial hypotension may facilitate the embolisation process and various agents, including glyceryl trinitrate and sodium nitroprusside, have been employed for this purpose.