Name of the Procedure:

Anesthesia for Therapeutic Interventional Radiological Procedures Involving the Arterial System; Carotid or Coronary

Summary

This procedure involves administering anesthesia to a patient undergoing a minimally invasive treatment on the carotid or coronary arteries, such as stent placement or angioplasty, performed under radiological guidance. The goal is to ensure the patient experiences no pain during the arterial intervention.

Purpose

The main purpose is to treat obstructed or narrowed arteries in the neck (carotid) or heart (coronary) to restore proper blood flow and prevent severe complications such as strokes or heart attacks. The anesthesia helps keep the patient comfortable and still during the procedure.

Indications

• Carotid artery stenosis (narrowing)
• Coronary artery disease
• Symptoms like chest pain, shortness of breath, or transient ischemic attacks (TIAs)
• Patients with significant risk factors for stroke or heart attack
• Inability to manage condition with medication or lifestyle changes alone

Preparation

• Fasting for 6-8 hours before the procedure
• Medication adjustments, particularly blood thinners
• Completing necessary diagnostic tests such as blood work, EKG, or imaging studies
• Consultation with the anesthesiologist to discuss medical history and anesthesia plan

Procedure Description

1. The patient is placed on the procedure table.
2. An IV line is inserted to administer fluids and medications.
3. Monitoring equipment (heart rate, blood pressure, oxygen levels) is attached.
4. The anesthesiologist administers anesthesia, which can range from local to general, depending on the case.
5. The radiologist performs the interventional procedure using specialized instruments and imaging technology to guide the treatment.
6. The patient remains under anesthesia throughout the procedure to ensure comfort and immobility.
7. Once the intervention is complete, anesthesia is gradually tapered off.

Duration

The procedure typically takes 1-3 hours, depending on the complexity.

Setting

This procedure is usually performed in a hospital's interventional radiology suite or specialized surgical center.

Personnel

• Interventional Radiologist
• Anesthesiologist
• Radiology Technologist
• Nurses
• Support Staff

Risks and Complications

• Common risks: bleeding, infection at the catheter site, reaction to anesthesia
• Rare risks: stroke, heart attack, allergic reaction, kidney damage from contrast dye
• Complication management: monitoring in hospital, medications, potential surgical intervention if necessary

Benefits

• Restoration of blood flow to critical areas
• Reduction in symptoms like chest pain or dizziness
• Reduced risk of future strokes or heart attacks
• Benefits often realized immediately post-procedure

Recovery

• Monitoring in a recovery room for several hours post-procedure
• Instructions on activity restrictions, such as avoiding heavy lifting
• Follow-up appointments to assess treatment success and adjust medications as needed
• Most patients can resume normal activities within a week, barring any complications

Alternatives

• Medication management
• Lifestyle changes (e.g. diet, exercise)
• Surgical options like carotid endarterectomy or coronary artery bypass grafting (CABG)
• Each alternative has its pros and cons, such as longer recovery for surgery versus the need for ongoing medication.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Post-procedure, there may be some discomfort or soreness at the catheter insertion site, but this is usually managed with pain medications. The patient might feel groggy or tired from the anesthesia, and it is typically advised that they rest for the remainder of the day.