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Association of Intraprocedural Blood Pressure and End Tidal Carbon Dioxide with Outcome After Acute Stroke Intervention

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Abstract

Background

General anesthesia (GA) for acute stroke interventions may be associated with inferior functional outcomes. Our goal was to identify physiologic parameters that mediate this association.

Methods

Consecutive patients treated at our institution between August 2007 and December 2010 were identified from a prospective database. Clinical data were then extracted by retrospective chart review. Variables significantly associated with outcome in univariate analysis were also examined in multivariate analysis, controlling for well-established prespecified predictors of functional outcome.

Results

Of the 106 patients identified, 20 were excluded (17 due to the absence of 90-day mRS and 3 due to insufficient anesthetic records). Blood pressure (BP) decreased significantly after induction of GA, but there was no association between BP and outcome. End tidal carbon dioxide values (ETCO2) at 60 and 90 min, however, were significantly associated with outcomes in both univariate and multivariate analyses. Mean ETCO2 in patients with favorable outcomes (modified Rankin Scale (mRS) 0–3) was higher than in those with unfavorable outcomes (mRS 4–6): 35.2 mmHg versus 32.2 (p = 0.03) at 60 min and 34.9 versus 31.9 (p = 0.04) at 90 min. The adjusted odds ratios for poor outcomes for each 1 mmHg decrease in ETCO2 were the same: 0.76 (95 % CI 0.65–0.92; p = 0.004) at 60 min and 0.76 (95 % CI 0.61–0.93; p = 0.01) at 90 min.

Conclusions

While BP decreased significantly in patients undergoing GA for acute stroke intervention, it did not correlate with patient outcome. Decreases in ETCO2 at 30 and 60 min, however, were associated with 90-day mRS.

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Funding

None.

Conflict of interest

Courtney Takahashi, Ansgar Brambrink, Michael Aziz, Elizabeth Macri, Joshua Raines, Anmol Multani-Kohol, Holly Hinson, Helmi Lutsep, Wayne Clark, and Jeremy Fields declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Neurointerventional Radiology, Kaiser Permanente, NW, Portland, OR, USA

    Jeremy D. Fields

  2. Department of Neurology, Oregon Health & Science University, Portland, OR, USA

    Courtney E. Takahashi, Elizabeth Macri, Joshua Raines, Holly E. Hinson, Helmi L. Lutsep, Wayne M. Clark & Jeremy D. Fields

  3. Oregon Stroke Center, Oregon Health & Science University, Portland, OR, USA

    Helmi L. Lutsep & Wayne M. Clark

  4. Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA

    Ansgar M. Brambrink & Michael F. Aziz

  5. Interventional Neuroradiology, Oregon Health & Science University, Portland, OR, USA

    Anmol Multani-Kohol

  6. Interventional Neuroradiology, Kaiser Permanente NW, Sunnyside Medical Center, 10180 Southeast Sunnyside Road, Clackamas, OR, 97015, USA

    Jeremy D. Fields

Authors
  1. Courtney E. Takahashi
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  2. Ansgar M. Brambrink
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  3. Michael F. Aziz
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  4. Elizabeth Macri
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  5. Joshua Raines
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  6. Anmol Multani-Kohol
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  7. Holly E. Hinson
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  8. Helmi L. Lutsep
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  9. Wayne M. Clark
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  10. Jeremy D. Fields
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Corresponding author

Correspondence to Jeremy D. Fields.

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Takahashi, C.E., Brambrink, A.M., Aziz, M.F. et al. Association of Intraprocedural Blood Pressure and End Tidal Carbon Dioxide with Outcome After Acute Stroke Intervention. Neurocrit Care 20, 202–208 (2014). https://doi.org/10.1007/s12028-013-9921-3

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  • DOI: https://doi.org/10.1007/s12028-013-9921-3

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