Will I be awake or under anesthesia during a cerebral endovascular procedure?
A cerebral endovascular procedure can be performed with general anesthesia or sedation. What determines this, what the anesthesiologist evaluates, and what waking up is like.
By Dr. Martin Roberto Casas MartínezOct 17, 20266 min read
In this article
- What determines whether I am put to sleep or kept awake?
- What is the difference between general anesthesia and sedation?
- What does the anesthesiologist review before the procedure?
- How will I be monitored during the procedure?
- What is waking up like, and can a family member stay with me?
- Frequently asked questions
- What should I ask before the procedure?
- References
Summary: During a cerebral endovascular procedure, you may receive general anesthesia (you are completely asleep, with a breathing tube) or sedation (medication that relaxes you without putting you fully to sleep). The anesthesia team determines the plan based on the type of procedure, its expected duration, and your health, and explains it to you beforehand.
One of the first questions that comes up when treatment for an aneurysm or another vascular lesion inside an artery is being considered is whether you will be awake or under anesthesia during a cerebral endovascular procedure. The short answer is “it depends,” and understanding what it depends on can help you come to your consultation with clear questions.
What determines whether I am put to sleep or kept awake?
It depends on the procedure and on you. A cerebral endovascular procedure can be performed under general anesthesia with a breathing tube, or with medication that relaxes you without putting you to sleep; the choice takes into account what will be done, how long it may take, and your overall health.
An endovascular procedure (inside the blood vessels) involves guiding a catheter (a thin, flexible tube) from an artery in the groin or wrist to the arteries in the brain, using X-rays and contrast dye. Metal coils are placed through the catheter, sometimes with a stent (a mesh that supports them).
The need for you to remain still, your age, and any preexisting conditions also play a role, so the plan is determined on a case-by-case basis.
What is the difference between general anesthesia and sedation?
With general anesthesia, you are unconscious throughout the procedure, and a tube placed in your airway helps you breathe. With sedation, you receive medication through a vein that relaxes you and may make you drowsy, but you breathe on your own and do not need a tube.
In both cases, local anesthesia (numbing of the skin) is used where the catheter is inserted. With sedation, it is normal to feel a prick when the intravenous line is placed and some pressure as the catheter is inserted.
Neither option is preferable in the abstract. General anesthesia provides immobility and control of breathing; sedation avoids the breathing tube and usually allows for faster recovery. Each has its own risks, which depend on your health and will be explained by the anesthesiologist before you give consent.
What does the anesthesiologist review before the procedure?
Before the procedure, the anesthesiologist (a physician who specializes in anesthesia) reviews your health history, medications, and allergies, and orders basic tests to choose the plan that is most appropriate for you. This assessment may take place during an office visit or by phone several days beforehand.
Tell the anesthesiologist about any heart or lung conditions, sleep apnea, previous problems with anesthesia, allergies to local anesthetics, general anesthesia, or contrast material, and, for women, the possibility of pregnancy. Common tests include blood and urine tests, an electrocardiogram, and, in some cases, a chest X-ray.
You will receive instructions about fasting and your medications: some medications that affect blood clotting may be temporarily stopped, while others may be started several days beforehand. Do not change any treatment on your own.
How will I be monitored during the procedure?
Throughout the procedure, monitors record your heart rate, blood pressure, and oxygen level, and an intravenous line is used to administer medications. With general anesthesia, the anesthesiologist also controls your breathing and the depth of your sleep.
The procedure is usually completed in one to two hours, although it may take several hours depending on its complexity. It is performed by a specialist in neurological endovascular therapy in an angiography suite, with the anesthesiologist present. If you are sedated, you may be asked to remain very still at certain times or respond to simple instructions; this communication is part of the monitoring.
What is waking up like, and can a family member stay with me?
After general anesthesia, the breathing tube is removed before you wake up completely, and you will spend some time in a monitored recovery area; it is common to feel drowsy, have a sore throat, or experience temporary nausea. With sedation, the effects wear off sooner.
In both cases, you will need to lie down for a while to protect the puncture site. If the aneurysm had not bled, hospitalization may last one to two days; if there was bleeding beforehand, the stay is usually longer.
During the procedure, family members wait outside the room; access to the recovery area depends on each hospital’s policies. It is a good idea to have someone you trust receive the discharge instructions and accompany you when you leave.
Frequently asked questions
Can I ask to be completely put to sleep if I am afraid?
You can express that preference, and the anesthesiologist will take it into account. However, general anesthesia has its own risks and is not always the most appropriate option; the decision considers your clinical needs, health, and informed opinion.
Will I feel pain when the catheter is inserted?
The puncture site is numbed with local anesthesia, so you will usually feel a prick followed by pressure rather than pain. What you feel varies from person to person; if you feel discomfort, let the team know so they can adjust the sedation or local anesthesia.
What if I have sleep apnea or other health conditions?
You should mention this during your pre-procedure assessment. Sleep apnea and heart or lung conditions may require an additional consultation with another specialist and can affect how the anesthesia and post-procedure monitoring are planned.
What should I ask before the procedure?
If you develop a sudden, severe headache or another sudden neurological symptom while waiting for the procedure, call 911 first. For your pre-procedure assessment, bring your medication list and recent test results, and consider asking these questions:
- •What type of anesthesia do you recommend for my procedure, and why?
- •Which anesthesia risks apply specifically to my case?
- •Which medications should I stop or start, and when?
For non-urgent questions or to request an individual assessment, you can contact the office.
Informational notice: This content is for informational purposes and does not replace a medical consultation or constitute a diagnosis.
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