Sixty-six patients (21.4%) had multiple aneurysms, and 12 patients were treated for two aneurysms at the same time. Mild (I, II), moderate (III), and severe (IV, V) HH grades were noted in 156 (50.6%), 75 (24.4%), and 77 patients (25%), respectively.
Eighty-eight patients (28.6%) exhibited hypertension, while 45 (14.6%) were smokers. A total of 104 patients (33.7%) were age 61 or older. The mean patient age was 55.5☑2.6 (standard deviation) years. The study sample was composed of 123 men (39.9%) and 185 women (60.1%). We continuously monitored patients’ vital signs, including blood pressure, heart rate, respiratory rate, oxygen saturation, and electrocardiography.ĭuring the study period, a total of 308 consecutive patients harboring 399 aneurysms who had presented with aneurysmal SAH were treated via EVT. We defined the procedure as being performed under LA with CS, according to whether or not neurologic examination was possible, regardless of the application of mechanical ventilation.
These procedures allowed for neurologic examination of patients undergoing mechanical ventilation. However, an anesthesiologist did not attend the administration of anesthetics, and inhaled anesthetics and muscle relaxant were not used, except for the continuous infusion of low-dose remifentanil and an additional bolus of midazolam or propofol, when necessary. Patients who were expected to exhibit unstable respiration were intubated for airway protection prior to the procedure and additional mechanical ventilation was applied to patients with respiratory failure due to initial neurologic severity. An additional bolus of low-dose of propofol or midazolam was administered if the procedure could not be continued due to patient immobility and agitation. Light sedation of Ramsay sedation scale at 2 or 3 was used to avoid respiratory depression, snoring, and maintain patient cooperation for neurologic evaluation. Ramsay sedation scale was used for assessment of the level of sedation. A low dose of intravenous remifentanil (0.02-0.1 μg/kg/min) was administered continuously for CS during the procedure. The groin was infiltrated with 5 mL of 1% lidocaine. EVT under LA with CS was considered for all patients with aneurysmal SAH, regardless of the Hunt and Hess (HH) scale score.