Society for Neuroscience in Anesthesiology and Critical Care Expert Consensus Statement

Abstract

Literature on the anesthetic management of endovascular treatment of acute ischemic stroke (AIS) is limited. Anesthetic management during these procedures is still mostly dependent on individual or institutional preferences. Thus, the Society of Neuroscience in Anesthesiology and Critical Care (SNACC) created a task force to provide expert consensus recommendations on anesthetic management of endovascular treatment of AIS. The task force conducted a systematic literature review (up to August 2012). Because of the limited number of research articles relating to this subject, the task force solicited opinions from experts in this area. The task force created a draft consensus statement based on the available data. Classes of recommendations and levels of evidence were assigned to articles specifically addressing anesthetic management during endovascular treatment of stroke using the standard American Heart Association evidence rating scheme. The draft consensus statement was reviewed by the Task Force, SNACC Executive Committee and representatives of Society of NeuroInterventional Surgery (SNIS) and Neurocritical Care Society (NCS) reaching consensus on the final document. For this consensus statement the anesthetic management of endovascular treatment of AIS was subdivided into 12 topics. Each topic includes a summary of available data followed by recommendations. This consensus statement is intended for use by individuals involved in the care of patients with acute ischemic stroke, such as anesthesiologists, interventional neuroradiologists, neurologists, neurointensivists, and neurosurgeons.

Endovascular treatment of acute ischaemic stroke under conscious sedation: Predictors of poor outcomes

“…[ 16 ] Those studies which did suggest superior outcomes with CS speculated that the haemodynamic parameters such as hypocapnia and hypotension may lead to poor outcomes under GA[ 14 15 ] and thus recommend the maintenance of normocapnia (35–45 mmHg) and SBP in the range of 140–180 mmHg. [ 17 ] In our study, we found no evidence of difficulty maintaining SBP in these patients. Indeed, most of these patients were hypertensive at presentation and several needed antihypertensive agents to lower intraprocedural SBP.…”

Aneurysmal Subarachnoid Hemorrhage

“…The Society for Neuroscience in Anesthesiology and Critical Care (SNACC) consensus statement opinioned that local anesthesia with anxiolytics can be used in neurologically cooperative patients for anterior circulation stroke who are able to protect the airway. 188 This recommendation lacked evidence from randomized trials. Similarly, endovascular coiling can be done for good grade ruptured aneurysms or unruptured aneurysms with local anesthesia with anxiolytics.…”

Acute ischemic stroke treatment using mechanical thrombectomy: A study of 137 patients

“…An expert consensus statement of the Society of NeuroInterventional Surgery and the Neurocritical Care Society[ 21 ] recommends the use of general anesthesia for patients with severe agitation, low level of consciousness (Glasgow coma scale <8), loss of airway protective reflexes, or respiratory compromise. [ 21 ] We preferred conscious sedation whenever possible. GA was administered in 59.9% of cases.…”