Blood pressure behavior during mechanical thrombectomy and drugs used for conscious sedation or general anesthesia

Abstract

Background: The optimal blood pressure (BP) during mechanical thrombectomy for acute ischemic stroke is currently unclear. Objective: To investigate BP behavior during mechanical thrombectomy in patients with acute ischemic stroke and its relationship with drugs used for sedation or general anesthesia. Additionally, we investigated the association between BP oscillation during mechanical thrombectomy and recanalization status, and with functional outcome at discharge. Methods: Consecutive patients treated with mechanical thrombectomy for acute ischemic stroke were evaluated in a tertiary hospital from December/2009 to December/2015. Maximum, minimum, and mean systolic and diastolic BP, and mean arterial pressures were collected during the procedure. Sedative drugs were also reviewed. Results: Fifty-three patients with a mean age of 71.9 years (60.4% men) were treated with mechanical thrombectomy. The mean reduction in systolic BP and mean arterial pressure from hospital admission to mechanical thrombectomy were respectively 42 and 36 mmHg. During the procedure, oscillations were 50.4 mmHg for systolic, and 33.2 mmHg for diastolic BP. Patients treated with neuromuscular blocking drugs had more oscillation in systolic BP from hospital admission to procedure (51.1 versus 26.2 mmHg, P=0.06). The use of cisatracurium (43.9 versus 29.6 mmHg, P=0.02) and succinylcholine (44.7 versus 29.3 mmHg, P=0.01) were associated with a significant drop in BP during the procedure. Conclusions: Significant BP oscillation occurs during mechanical thrombectomy. Drugs used for conscious sedation or general anesthesia, specifically neuromuscular blocking agents, might have an influence upon BP levels.

Estrategia De Enfermería Para Disminuir Ansiedad Del Paciente en Procedimientos Endoscopicos: Ensayo Clínico Aleatorizado

“…Por el contrario, otros autores, que utilizaron estrategias como la música, entorno relajado, meditación, distracción visual y auditiva, etc., estos no lograron revelar un impacto significativo en los niveles de presión arterial en procedimientos endoscópicos (3,6) . Un hallazgo interesante (29) que podría explicar estas diferencias, señala que los cambios de presión arterial pueden ocurrir por diferentes tipos de anestesia y/o medicamentos, que comparado con el pabellón de procedimientos endoscópicos del hospital en estudio, el tipo de anestesia se mantuvo constante y no se administraron sedantes, por lo tanto, los resultados se debieron al acompañamiento significativo que tuvo el paciente en la etapa intra y postprocedimiento. Con respecto a los parámetros de la frecuencia cardiaca, los resultados fueron bastante claros al informar que hubieron diferencias significativas entre los grupos en la etapa pre (p= 0,003) y postprocedimiento (p= 0,0003), lo que es consistente con estudios anteriores (1,9,30) , pero contrario a otros que no lograron reportar cambios o diferencias significativas en estudios endoscópicos (3,6) .…”

Blood Pressure Changes During Mechanical Thrombectomy for Acute Ischemic Stroke Are Associated With Serious Early Treatment Complications: Symptomatic Intracerebral Hemorrhage and Malignant Brain Edema

“…Significant oscillations of periprocedural blood pressure (BP) in patients with acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT) are now considered to be a common finding ( 1 ). Accumulating evidence indicates that they may influence treatment outcomes.…”