Anaesthetic support for mechanical thrombectomy should involve anaesthetic staff with appropriate training and experience in neuro-anaesthetic care and remote site anaesthesia. Operating department practitioner/anaesthetic nurse support should be available.30
Protocols should be developed to ensure that accurate clinical information is available in a timely manner to the anaesthetist to avoid any delays in treatment. There should be an agreed process for alerting the mechanical thrombectomy team if anaesthetic provision is unavailable to allow referral to another mechanical thrombectomy centre.
The decision whether to perform mechanical thrombectomy under local or general anaesthesia is based on the individual patient; with close communication with the neurointerventionalist. All patients should receive monitoring with the provision to convert to a general anaesthetic if needed.13
Agreed local guidelines should include who should be managed under general anaesthesia.
Anaesthetic care should be consultant or autonomously practising anaesthetist led, when possible. A neurocritical care facility should be available if needed after the procedure or a monitored bed on a hyperacute stroke unit as appropriate.
All units should audit their practice regularly to look at types of anaesthesia, timing, agents used and complications and review of service delivery.
All staff working in MRI units must be trained in MR safety. The use of checklists before transfer to the scanner should be routine.29
Neurocritical care should commence/continue in theatre; therefore standard operating protocols for invasive lines, monitoring and tracheal tubes should reflect local critical care policy.
Departments of emergency medicine may also wish to adopt these standard operating procedures.
Whether in a dedicated paediatric neurosurgical unit or not, every child requiring elective neurosurgery should have care delivered by an anaesthetist or anaesthetists who possess the relevant competencies as demanded by the patient’s age, disease and comorbidities.
