impact on general anaesthesia requirement Dr Nicola H Strickland Consultant Radiologist Imperial College Healthcare NHS Trust President Royal College of Radiologists Radiology and Anaesthetics ID: 677153
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Slide1
Future directions in Radiology: impact on general anaesthesia requirement
Dr
Nicola H Strickland
Consultant Radiologist, Imperial College Healthcare NHS Trust
President Royal College of RadiologistsSlide2
Radiology and Anaesthetics: interdependent specialties
f
uture directions of radiology
impact on
anaesthetics
d
emands of
anaesthetists
(e.g. ITU)
impact on radiology
b
oth regarded as “service specialties”
n
eed to enhance profile with clinical colleagues and publicSlide3
Current and future radiological procedures requiring anaesthetist support
g
eneral
anaesthesia
:
painful procedures
u
reteric stent insertion
e
ndovascular aneurysm repair EVAR
v
enoplasty
and venous stents
c
omplex percutaneous
transhepatic
cholangiographic
procedures PCTA
i
mage guided bone biopsy
n
eurointervention
– coil/balloon placement: subarachnoid
haemorrhage
, AVMs
i
nterventional oncology
supervised pain relief and
sedation
→
safe
, stable conscious level
mechanical
thrombectomySlide4
Demands of anaesthetists on radiology
i
ntubation
difficult airways
ITU
s
erial chest x-ray interpretation: radiologist “ward rounds”
s
imple ultrasound diagnoses: ascites, pleural effusions
u
ltrasound guided vessel location and on ward drainages
s
udden intracranial pathology: CT, sometimes MR
a
cute deterioration – abdominopelvic pathology: CT
l
ine retrievalSlide5
general anaesthesiasupervised pain relief and sedation
Current and future radiological procedures requiring anaesthetist supportSlide6
Double J ureteric stents
courtesy Dr Steven MoserSlide7
EVAR: endovascular aortic aneurysm repairSlide8
EVAR: right and left renal artery stents
courtesy Dr Rob ThomasSlide9
EVAR: superior mesenteric artery stentSlide10
EVAR: final result with branch stents
2 left renal
a
rtery stents
r
ight renal
artery
stent
s
ma
stentSlide11
Aorto-oesophageal fistulaSlide12
Aorto-oesophageal fistula – coated thoracic aortic stent placement
courtesy
Dr Rob ThomasSlide13
Venoplasty and venous stentspatient with metastatic adenocarcinoma of the right adrenal gland causing IVC obstructionSlide14
Coronal CT reconstructions showing IVC occluded by tumourSlide15
bilateral venogram showing occluded IVC and numerous venous collaterals
courtesy
Dr
Rob ThomasSlide16
Deployment of IVC filterSlide17
Deployment of IVC stentsSlide18
Final result: patent stented IVC, filter removedSlide19
p/w Lt hemianopia and confusion
Delayed CTA
Neurointervention
: aneurysmal bleedSlide20
anterior
aneurysm
Neurointervention: aneurysmal bleed
courtesy
Dr
Neil
RaneSlide21
Diagnosis
:
Mycotic
Aneurysm
History of endocarditis
Neurointervention
: aneurysm glue occlusionSlide22
Interventional oncology: RFASlide23
Current and future radiological procedures requiring anaesthetist support
g
eneral
anaesthesia
: painful procedures
u
reteric stent insertion
e
ndovascular aneurysm repair EVAR
v
enoplasty
and venous stents
c
omplex percutaneous
transhepatic
cholangiographic
procedures PCTA
i
mage guided bone biopsy
n
eurointervention
– coil/balloon placement: subarachnoid
haemorrhage
, AVMs
i
nterventional oncology
supervised pain relief and
sedation
→
safe
, stable conscious level
mechanical
thrombectomySlide24
Mechanical thrombectomy: removal of thrombus from proximal left middle cerebral arterySlide25
IntubationITUDemands of anaesthetists on radiologySlide26
29y woman with severe endobronchialWegener’s granulomatosisSlide27
Hysteresis loop
expiration markedly flattenedSlide28
CT reconstructions in subglottic stenosisSlide29
Subglottic tracheal stenosisSlide30
ITUChest X-raysDemands of anaesthetists on radiologySlide31
Chest X-ray: pneumothorax
Erect
SupineSlide32
CXR: tension pneumothoraxSlide33
Subtle pneumothorax: deep sulcus signSlide34
If in doubt do a CT: subtle pneumothorax? bulla?
“crisp” cardiac silhouetteSlide35
ITUacute deteriorationDemands of anaesthetists on radiologySlide36
Acute intracerebral haemorrhageSlide37
ITU acute deterioration: closed loop obstructionSlide38
ITU: Hx “overdose, in cardiogenic shock, worsening ventilation, lactate rising, severe rhabdomyolysis. Progressive peripheral ischaemia”Slide39
ITUline retrievalDemands of anaesthetists on radiologySlide40
Fractured portacath in RV and pulmonary arterySlide41
Retrieval of fractured portacathSlide42
Conclusion:Future directions in Radiology:
impact on general anaesthesia
requirement
i
nterventional radiology becoming increasingly more complex
→
greater GA requirement
cancer patients surviving longer, more interventional oncology
→
greater GA
requirement
↑mechanical stroke
thrombectomy