Anesthetic Management and Outcome in Patients During Endovascular Therapy for Acute Stroke

Davis, Melinda; Menon, Bijoy K; Baghirzada, Leyla; Campos-Herrera, Cynthia Resende; Goyal, Mayank; Hill, Michael D; Archer, David P.

doi:10.1097/sa.0b013e31827f3137

Cited by 79 publications

(137 citation statements)

References 2 publications

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“…7 Davis et al retrospectively compared patients who underwent GA with those who had local anesthetic complimented by "light sedation" with midazolam and fentanyl. 15 Results indicated that after controlling for stroke severity, outcomes were poorer in the GA group (60% vs 15%, p < 0.0001). The authors pinpointed hypotension, which was more frequent in the GA group, as a contributing culprit.…”

Section: Discussionmentioning

confidence: 86%

“…Another key parameter that we were not able to reliably access in our chart reviews was hypotension; previous authors have suggested the hemodynamic instability involved in GA as causative of increased ischemic damage in acute stroke. 15 Finally, the long duration of this retrospective study (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) means that technology and technique have evolved significantly over the course of our study.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of General Anesthesia and Conscious Sedation in Endovascular Treatment for Stroke

Just

Rizek

Tryphonopoulos

et al. 2016

Can. J. Neurol. Sci.

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Background: Recent studies have strongly indicated the benefits of endovascular therapy for acute ischemic stroke, but what remains a continued debate is the role for general anaesthesia versus conscious sedation (CS) for such procedures. Retrospective studies have found poorer neurological outcomes in patients who underwent general anesthesia (GA); however, some have revealed worse baseline stroke severity in these patients. Methods: This study is a retrospective cohort study aimed at comparing mortality and morbidity of GA versus CS in patients treated with endovascular intervention in acute ischemic stroke. Chi-square and t-test analyses were used. Results: Patients in the GA (n = 42) group were more likely to be deceased than those in the CS (n = 67) group at hospital discharge, 3 months, and 6 months poststroke onset. Morbidity, as defined by modified Rankin Score, was significantly greater in the GA group at hospital discharge, and a similar trend was seen in morbidity at 3 months postdischarge. Conclusion: General anesthesia for endovascular intervention in acute ischemic stroke was associated with increased mortality and poorer neurological incomes compared with conscious sedation. In our study, age, gender, history of hypertension, history of diabetes, and baseline National Institute of Health Stroke Scale were not significantly different between the groups. Although the need for a randomized, prospective study on this topic is clear, our study represents further corroboration of the safety and efficacy of conscious sedation in these procedures.RÉSUMÉ: Résultats de l'anesthésie générale et de la sédation consciente dans le traitement endovasculaire de l'accident vasculaire cérébral. Contexte : Des études récentes ont montré clairement les bénéfices du traitement endovasculaire de l'accident vasculaire cérébral aigu ischémique (AVCI). Cependant le débat sur l'utilisation de l'anesthésie générale versus la sédation consciente (SC) lors de telles interventions se poursuit. Des études rétrospectives ont révélé que les résultats neurologiques étaient moins bons chez les patients qui avaient subi une anesthésie générale (AG). Cependant, selon certaines études, l'AVC était plus sévère chez ces patients. Méthodologie : Nous avons effectué une étude de cohorte rétrospective dans le but de comparer la mortalité et la morbidité de l'AG et celle de la SC chez des patients qui avaient subi une intervention endovasculaire pour un AVCI. Nous avons utilisé le test du chi-carré et le test de t pour analyser les données. Résultats : Les patients du groupe AG (n = 42) étaient plus susceptibles d'être décédés que ceux du groupe SC (n = 67) soit au moment du congé hospitalier, 3 mois et 6 mois après le début de l'AVC. La morbidité, évaluée au moyen du score modifié de Rankin, était significativement plus importante dans le groupe AG au moment du congé hospitalier et on notait une tendance similaire 3 mois après le congé hospitalier. Conclusion : L'anesthésie générale lors d'une intervention endovasculaire pour un ...

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Outcomes of General Anesthesia and Conscious Sedation in Endovascular Treatment for Stroke

Just

Rizek

Tryphonopoulos

et al. 2016

Can. J. Neurol. Sci.

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“…For neuroanesthesiologists, the debate is on how to choose the anesthetic technique, GA versus monitored anesthesia care (MAC). Retrospective data consistently show the better outcome associated with MAC in acute ischemic stroke patients undergoing mechanical recanalization (52,53). Therefore, it appears that MAC should be the preferred technique in this patient population.…”

Section: Outcome-oriented Care: Defining the Role Of Neuroanesthesiolmentioning

confidence: 99%

Practice Trends and Research Priorities of Neurosurgical Anesthesia

Meng¹,

Li²,

Gelb³

2015

J Anesth Perioper Med

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Aim of review:One of the goals of neurosurgical anesthesia is to facilitate the execution of neurosurgical procedures including intraoperative neurological monitoring. However, it should also and always aim at benefiting the patients by improving the patient's long-term and disease-specific outcomes. Method: In this review, we highlighted some perspectives of today's practice trends and research priorities of neurosurgical anesthesia for the purpose of exploring the best care based on evidence, and speculation where relevant evidence is lacking. Recent findings: The advancement in general anesthesia and better understanding of neurological diseases have promoted the evolution of the sub-specialty of neurosurgical anesthesia. Facilitating modern neurosurgical procedures including intraoperative neurological monitoring is a priority of neurosurgical anesthesia. However, a focus on the patient outcomes can never be over-emphasized. The effect of any component of anesthesia care, such as drugs choice and dose, ventilation management, and intravascular volume and cardiac output care, on patient's outcome should be appraised by quality research. Summary: It is important to recognize that different patient populations have different and disease/surgery-specific outcomes that should also be taken into account during the customization of anesthesia techniques. ABSTRACT

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“…[10,12]. In Analogie zu Jumaa et al [10] fand sich in der vorliegenden Studie sowohl bei Verschlüssen im vorderen (6,5 ± 3,7 Tage vs. 9,6 ± 4,1 Tage) als auch im hinteren (6,3 ± 2,9 Tage vs. 7,9 ± 3,7 [24]. In 2 weiteren aktuellen Studien konnte die Korrelation zwischen Intubationsnarkose und schlechterem klinischem Outcome bestätigt werden [25,26].…”

Section: Introductionunclassified

“…Ebenso kann das Überstrecken des Kopfes zu einer Alteration der kraniozervikalen Gefäße und der Perfusion führen, vor allem bei vorgeschalteter Stenose [24]. Darüber hinaus kommt es durch den Zeitbedarf für die Narkoseeinleitung zu einer Verzögerung von Interventionsbeginn und konsekutiv damit auch dem Zeitpunkt der Rekanalisation [12,28].…”

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Endovaskuläre Therapie des akut ischämischen Schlaganfalls unter Analgosedierung im Vergleich zur Intubationsnarkose - Durchführbarkeit, periprozedurale Sicherheit, klinisches und radiologisches Outcome

Langner

Khaw

Fretwurst

et al. 2013

Fortschr Röntgenstr

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Abstract! Purpose: Vessel recanalization is an important predictor of clinical outcome in the treatment of acute ischemic stroke. Endovascular therapies are used with increasing frequency. There is no general agreement on the policy of anesthesia during endovascular therapy, ranging from general anesthesia (GA) to local anesthesia at the puncture site with conscious sedation (CS) as needed. The aim of the study was to evaluate the safety and feasibility and radiological and clinical outcome of endovascular stroke therapy under CS. Materials and Methods: We retrospectively included all patients with acute ischemic stroke who were treated with endovascular therapy over a five-year period. Data was evaluated with respect to type of sedation, conversion from CS to GA, recanalization rate, infarct volume and peri-and postprocedural complications. Results: There was a technical failure in 7 patients. Of the remaining 124 patients (mean age 68.8 ± 14.6 years), 65 were female (52 %). The site of occlusion was located in the anterior circulation in 94 patients (76 %) and in the posterior circulation in 30 cases (24 %). 105 patients (85 %) were treated under CS and 16 cases (13 %) primarily under GA. In 3 cases (2 %) peri-procedural conversion to GA was necessary. Primary intra-arterial thrombolysis, mechanical recanalization only, and combination therapy were performed in 60 (48 %), 27 (22 %) and 37 (30 %) patients, respectively. There were no significant differences for recanalization rate and complications between GA and CS. The mean procedure time was significantly shorter in patients treated under CS (p < 0.01). Conclusion: Endovascular stroke therapy with CS is feasible, can be performed safely and is faster than with GA.Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.Einleitung

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Anesthetic Management and Outcome in Patients During Endovascular Therapy for Acute Stroke

Cited by 79 publications

References 2 publications

Outcomes of General Anesthesia and Conscious Sedation in Endovascular Treatment for Stroke

Outcomes of General Anesthesia and Conscious Sedation in Endovascular Treatment for Stroke

Practice Trends and Research Priorities of Neurosurgical Anesthesia

Endovaskuläre Therapie des akut ischämischen Schlaganfalls unter Analgosedierung im Vergleich zur Intubationsnarkose - Durchführbarkeit, periprozedurale Sicherheit, klinisches und radiologisches Outcome

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