Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke During COVID-19 Pandemic: Consensus Statement From Society for Neuroscience in Anesthesiology & Critical Care (SNACC)

Abstract

The pandemic of coronavirus disease 2019 has unique implications for the anesthetic management of endovascular therapy for acute ischemic stroke. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert recommendations using available evidence for the safe and effective anesthetic management of endovascular therapy for acute ischemic stroke during the COVID-19 pandemic. The goal of this consensus statement is to provide recommendations for anesthetic management considering the following (and they are): (1) optimal neurological outcomes for patients; (2) minimizing the risk for health care professionals, and (3) facilitating judicious use of resources while accounting for existing variability in care. It provides a framework for selecting the optimal anesthetic technique (general anesthesia or monitored anesthesia care) for a given patient and offers suggestions for best practices for anesthesia care during the pandemic. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.

Canadian Stroke Best Practice Guidance During the COVID-19 Pandemic

“…This does not imply the need to intubate more patients, and we continue to recommend that monitored anaesthesia is preferred unless there is a clinical indication for intubation. 5 Similarly, recent multisociety guidance agrees that intubation is not necessary for all suspected or confirmed COVID-19 patients. 11,12 The minimum possible sedation should be used in COVID-19 suspected patients, to reduce the risk that bag-mask ventilation, an aerosol-generating procedure, would be required.…”

“…We encourage clinicians to amend their practices but not to deviate from evidence-based care. 5 We do not suggest amending acute stroke computed tomography (CT)-angiography protocols to include CT of the chest to look for signs of COVID-19. The diagnostic value of CT chest for COVID-19, including false positive and negative rates, is not well defined at present.…”

“…Patients with a dual diagnosis of acute stroke and COVID-19 may be admitted to a nonstroke unit with HCP less experienced at providing stroke care and early rehabilitation. 5 In these instances, there should be processes in place for consultation with stroke experts and education on stroke best practices. 14 Particularly important is education for the recognition, assessment, and management of dysphagia, aphasia, cognitive impairment, handling and positioning of hemiplegic extremities, venous thromboembolism prevention, transfers, and fall prevention.…”

“…Health systems in Canada face immense challenges, both to cope with the number of affected patients and the constraints imposed by containment measures such as physical distancing, quarantine, and personal protection. Stroke care across the globe and within Canada is rapidly changing to meet these challenges [1][2][3][4][5][6][7] (see Appendix 1 in Supplementary material).…”

COVID-19 pandemic: A stress test for interventional radiology

“…For COVID-19 patients with mild symptoms or no risk of progressive disease, postponing the procedure until complete recovery (3 to 4 weeks after the onset of symptoms) may be an option. If the procedure cannot be delayed for a patient who is actually affected by COVID-19, such as emergencies involving life-threatening conditions or severe symptoms or progressive disease, treatment should be undertaken using a full deployment of the personal protective equipment and following the recommendations on protecting, cleaning and disinfecting the facility [13,14]. Compared to other techniques including surgery, IR may generate a paradigm shift in the management of these patients, although some changes have to be made in the patient workflow [15].…”