Abstract Neuroradiology has had a long association with anaesthesia, and the development of new imaging techniques have been made possible by developments in anaesthetic practice. However, recent advances in diagnostic neuroradiology demand new refinements in anaesthetic technique. Further, the growth of interventional and image guided therapeutic procedures has posed an entirely new set of challenges, not least because it opens up the option of treating patients who may have been previously considered too high a risk for operative intervention. Of particular interest are the developments in intravascular interventional neuroradiology and interventional magnetic resonance imaging. The availability of novel anaesthetic agents and techniques, along with new commercially available equipment, provides the prospect of being able to meet these challenges and deliver safe and effective anaesthesia in demanding environments.