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Is periprocedural sedation during acute stroke therapy associated with poorer functional outcomes?
  1. C Nichols1,
  2. J Carrozzella2,
  3. S Yeatts3,
  4. T Tomsick2,
  5. J Broderick2,
  6. P Khatri2
  1. 1South Denver Neurosurgery, Littleton Adventist Hospital, Colorado, USA
  2. 2University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
  3. 3Medical University of South Carolina, South Carolina, USA
  1. Correspondence to Dr C Nichols, South Denver Neurosurgery, Littleton Adventist Hospital, 7780 South Broadway, Suite 260, Littleton, CO 80122, USA; cwnich{at}gmail.com

Abstract

Background To safely perform acute intra-arterial revascularization procedures, use of sedative medications and paralytics is often necessary. During the conduct of the Interventional Management of Stroke trials (I and II), the level of sedation used periprocedurally varied. At some institutions, patients were paralyzed and intubated as part of the procedural standard of care while at other institutions no routine sedation protocol was followed. The aim of this study was to identify patient characteristics that would correlate with the need for deeper sedation and to explore whether levels of sedation relate to patient outcome.

Methods 75 of 81 patients in the Interventional Management of Stroke II Study were studied. Patients had anterior circulation strokes and underwent angiography and/or intervention. Four sedation categories were defined and tested for factors potentially associated with the level of sedation. Clinical outcomes were also analyzed, including successful angiographic reperfusion and the occurrence of clinical complications.

Results Only baseline National Institutes of Health Stroke Scale varied significantly by sedation category (p=0.01). Patients that were in the lower sedation category fared better, having a higher rate of good outcomes (p<0.01), lower death rates (p=0.02) and higher successful angiographic reperfusion rates (p=0.01). There was a significantly higher infection rate in patients receiving heavy sedation or pharmacologic paralysis (p=0.02) and a trend towards fewer groin related complications.

Conclusion In this small sample, patients not receiving sedation fared better, had higher rates of successful angiographic reperfusion and had fewer complications. Further examination of the indications for procedural sedation or paralysis and their effect on outcome is warranted.

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Footnotes

  • Funding The IMS II study was funded by the National Institute of Neurological Diseases and Stroke (NDS No NS39160) and EKOS Corporation.

  • Competing interests JPB has acted as a consultant for Genentech Inc.

  • Ethics approval This study was conducted with the approval of the University of Cincinnati institutional review board.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

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