National survey on perioperative anaesthetic management in the endovascular treatment of acute ischaemic stroke

Kräuchi, O. Romero; Valencia, Lucía; Iturri, F.; Ortega, A. Mariscal; Gómez, A. López; Valero, Ricard

doi:10.1016/j.redare.2017.11.007

Cited by 3 publications

(3 citation statements)

References 47 publications

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“…An interesting analysis regarding the situation in various centers in Spain was performed by Kräuchi et al In particular, in the majority of cases, the choice of anesthesia was shared with neuroradiologists, in accordance with the clinical conditions of patients, such as cardiovascular or respiratory parameters. The same theory of the individualization of anesthesia strategy is shared by Talke et al in their study [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 65%

Anesthesia for Endovascular Therapy for Stroke

Gaspari,

Vaccari,

Arturi

et al. 2024

Neurology International

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Background: In patients with acute ischemic stroke, the standard of care is to perform intra-arterial endovascular thrombectomy in addition to intravenous thrombolysis. In this study, we investigated the different anesthetic techniques chosen for this procedure and clinical outcomes. Methods: Patients undergoing endovascular procedures were divided into three groups. The first group consisted of patients who received general anesthesia, the second group underwent the procedure under conscious sedation and local anesthesia at the catheter insertion site, and lastly the third group included patients who received only local anesthesia at the catheter insertion site, without sedation. Results: During the endovascular procedure, we did not notice significant differences in vital parameters, in particular the mean blood pressure (MAP) between patients treated with different types of anesthesia. Also, the duration of the revascularization did not show significant differences between the three groups. The main point is the absence of differences in terms of functional and clinical outcomes, using various scores as reference, such as the National Institutes of Health Stroke Scale (NIHSS) score at 7 days, NIHSS and Modified Rankin Scale (MRS) at time of discharge, and MRS after 3 months. These scores did not show significant differences in groups treated with different types of anesthesia. Conclusions: The rate of success of the revascularization procedure is almost overlapping between patients treated with conscious sedation and general anesthesia. In addition, we did not notice significant differences between groups in terms of functional and clinical outcomes. Considering the possible usefulness of applying conscious sedation, at OCSAE of Baggiovara, an internal protocol for conscious sedation was introduced to standardize the treatment in patients undergoing endovascular procedures.

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Section: Discussionmentioning

confidence: 65%

Anesthesia for Endovascular Therapy for Stroke

Gaspari,

Vaccari,

Arturi

et al. 2024

Neurology International

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“…When anesthesiologists are not routinely involved with EVT, CS is usually provided by sedation-trained nurses (STNs) under the supervision of neurointerventionalists, with anesthesiology involvement on an as-required basis. 2,3 Before October 2020, sedation management during EVT at Penn State Hershey Medical Center was provided by STNs under the supervision of advanced cardiac life support and moderate sedation certified neurointerventionalists with anesthesia involvement requested only if airway compromise was present or suspected. In October 2020, our institution introduced routine involvement of anesthesia services during EVT.…”

Section: Introductionmentioning

confidence: 99%

“…To perform EVT safely, conscious sedation (CS) or general anesthesia (GA) is often required. When anesthesiologists are not routinely involved with EVT, CS is usually provided by sedation-trained nurses (STNs) under the supervision of neurointerventionalists, with anesthesiology involvement on an as-required basis 2,3 …”

mentioning

confidence: 99%

Demonstrating the Value of Routine Anesthesiologist Involvement in Acute Stroke Care: A Retrospective Chart Review

McCusker¹,

Chinchilli

Fritch³

et al. 2023

Journal of Neurosurgical Anesthesiology

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Introduction: The value of routine involvement of anesthesiologists during endovascular thrombectomy (EVT) for acute ischemic stroke has not been clearly demonstrated. At some institutions, anesthesiologists are involved only as needed, while at other institutions, anesthesiologists are involved from the beginning for every EVT. Methods: We retrospectively analyzed the workflow, intraprocedural variables and complications, and outcomes in acute ischemic stroke patients undergoing EVT at a comprehensive stroke center after implementation of routine involvement of an anesthesia team and compared this cohort with patients who received care from sedation-trained nurses working under the supervision of neurointerventionalists with the involvement of anesthesiologists on an as-needed basis. Results: Routine involvement of anesthesiologists was associated with improved workflow performance measures, including decreased median door-to-arterial puncture time (68 min; interquartile range (IQR), 15.5–94.5 min vs. 81 min; IQR, 53–104 min; P=0.001), in-room to arterial puncture time (11 min; IQR, 8–14 min vs. 15 min; IQR, 9–21 min; P<0.0001), and procedure time (51 min; IQR, 40–64 min vs. 60 min; IQR, 40–88.5 min; P=0.007). It was also associated with a nonsignificant trend towards lower rates of desaturation events (8.2% vs. 3.4%; P=0.082) and lower rates of conversion to general anesthesia (1.7% vs. 0%; P=0.160). Ninety-day modified Rankin scores were similar regardless of provider type. Conclusion: Implementation of routine involvement of an anesthesia team during EVT was not associated with improved outcomes but was associated with improved efficiency and greater adherence to guidelines-based physiological parameters, supporting the routine involvement of anesthesiologists during EVT.

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Monitored Anesthesia Care by Sedation-Trained Providers in Acute Stroke Thrombectomy

et al. 2019

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Background: Mechanical thrombectomy (MT) for ischemic stroke can be performed under local anesthesia (LA), conscious sedation (CS), or general anesthesia (GA). The need for monitoring by anesthesia providers may be resource intensive. We sought to determine differences in outcomes of MT when sedation is performed by an anesthesia team compared to sedation-trained providers. Methods: We performed a retrospective analysis on patients who were screened by a pre-hospital stroke severity screening tool and underwent MT at two stroke centers. Baseline characteristics, time metrics, sedatives, peri-procedural intubation, complications, and outcomes were recorded. Good outcome was defined as modified Rankin score of ≤2. Results: We analyzed 104 patients (sedation-trained provider = 63, anesthesia team = 41) between July 2015 and December 2017. In the sedation-trained provider group, four patients required intervention by an anesthesia team. There were no differences in patients receiving LA (sedation-trained provider 24% vs. anesthesia team 27% p = 0.82), CS (70 vs. 63%, p = 0.53), or GA (6 vs. 10%, p = 0.71) between groups. Sedation-trained providers were more likely to use only one drug during the procedure (62 vs. 34%, p = 0.009). The rate of procedural complications (9.5 vs. 4.5%, p = 0.48), good outcome (56 vs. 39%, p = 0.11), and mortality (22 vs. 24%, p = 0.82) was similar between groups. Sedation by provider type did not predict functional outcome or mortality at 3 months. Conclusions: Sedation-trained providers are capable of delivering appropriate sedation without compromising patient safety. The use of “as needed” anesthesia teams for MT may have considerable effect on resource allocation and cost.

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National survey on perioperative anaesthetic management in the endovascular treatment of acute ischaemic stroke

Cited by 3 publications

References 47 publications

Anesthesia for Endovascular Therapy for Stroke

Anesthesia for Endovascular Therapy for Stroke

Demonstrating the Value of Routine Anesthesiologist Involvement in Acute Stroke Care: A Retrospective Chart Review

Monitored Anesthesia Care by Sedation-Trained Providers in Acute Stroke Thrombectomy

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