The procedures
In interventional radiology, a specialist doctor guides fine wires and catheters through blood vessels or tissues using live images. Procedures I commonly provide anaesthesia for include:
- Neurovascular procedures: treating blood vessels in the brain from the inside, for example placing tiny coils or devices in an aneurysm (coiling), removing a clot that is causing a stroke (thrombectomy), or treating abnormal connections between arteries and veins.
- Embolisation: deliberately blocking a blood vessel to stop bleeding, shrink a tumour or fibroid, or reduce blood supply before surgery.
- Line insertion and drainage: placing long-term intravenous lines or ports, or drains for fluid collections.
Many procedures take place in a radiology suite or angiography room rather than an operating theatre.
The role of your specialist anaesthetist
Many interventional procedures are done with local anaesthetic alone. An anaesthetist is involved when a procedure needs you to be completely still for a long time, is likely to be uncomfortable, or when your health needs closer monitoring and support. My role is to keep you safe and comfortable, to provide the conditions the radiologist needs, and for brain procedures, to manage blood pressure carefully to protect the brain.
Sedation or general anaesthesia
- Sedation helps you relax and feel drowsy while still breathing on your own. It is often combined with local anaesthetic at the puncture site. You may remember parts of the procedure.
- General anaesthesia is used when complete stillness is important, such as for many brain aneurysm treatments, when a procedure is long or painful, or when you would not be comfortable lying flat while awake.
For stroke thrombectomy, the choice between sedation and general anaesthesia is made quickly, based on your condition and the needs of the procedure. In other situations, we decide together beforehand. Neither approach is right for everyone.
Preoperative assessment and preparation
I will review your general health, your medications and any previous reactions to anaesthesia or to X-ray contrast (the dye used to show blood vessels). Please tell us about any kidney problems, diabetes, or allergies, including to iodine-based contrast. Some procedures need blood thinners to be adjusted or continued in a particular way; this is decided individually by your treating team, so please do not change any medication unless you have been advised to. See Medications Before Anaesthesia and Preparing for Your Procedure for fasting and other preparation.
What happens during the procedure
The radiology suite contains large imaging equipment that moves around you, and the room is often kept cool. You will lie on a narrow table, with padding and warming to keep you comfortable. Standard monitoring includes heart tracing, blood pressure, oxygen levels and, under sedation or general anaesthesia, your breathing. For brain procedures and longer cases, an arterial line is often placed to measure blood pressure continuously.
Working in a remote location. Radiology suites are usually some distance from the main operating theatres. Anaesthesia there is provided to the same safety standards as in an operating theatre, with the same monitoring, airway and emergency equipment, a trained anaesthetic assistant, and plans for getting extra help quickly if it is needed.
Radiation. X-ray doses are kept as low as reasonably possible. The team wears protective lead, and the radiologist will discuss any radiation considerations relevant to you, especially if you could be pregnant.
Recovery and postoperative considerations
After a catheter procedure through the groin or wrist, you will need to lie still for a period while the puncture site seals, and nurses will check it regularly. After most brain procedures you will be monitored in a high-dependency or intensive care unit, sometimes overnight. Some line insertions and simpler procedures are day procedures, in which case you will need a responsible adult to take you home and stay with you. See Recovery & Aftercare.
Relevant anaesthetic risks and precautions
The common side effects of sedation and anaesthesia, such as nausea and drowsiness, apply. With sedation, breathing can occasionally slow, which is why oxygen levels and breathing are monitored closely and sedation can be adjusted at any time. Contrast dye can rarely cause an allergic reaction or affect kidney function, particularly in people with existing kidney disease. For brain procedures, careful blood pressure management is part of reducing the risk of bleeding or stroke.
Your radiologist will explain the risks of the procedure itself. See Anaesthetic Safety & Risks for anaesthetic risks in context.
Links to additional patient resources
- Preparing for Your Procedure
- Understanding Your Anaesthetic & Informed Consent
- Medications Before Anaesthesia
- Recovery & Aftercare
- InsideRadiology, patient information from the Royal Australian and New Zealand College of Radiologists (RANZCR)