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E-277 General anesthetic management for endovascular treatment of acute ischemic stroke
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  1. S Deschner1,
  2. J Haggard1,
  3. J Frank2,
  4. M Al-Kawaz3,
  5. K Pennypacker3,
  6. A Trout2,
  7. A Stowe3,
  8. D Dornbos4,
  9. S Pahwa4,
  10. J Fraser4
  1. 1College of Medicine, University of Kentucky, Lexington, KY
  2. 2Department of Neurological Surgery, University of Kentucky, Lexington, KY
  3. 3Department of Neurology, University of Kentucky, Lexington, KY
  4. 4Department of Neurological Surgery, Department of Radiology, University of Kentucky, Lexington, KY

Abstract

The impact of general anesthesia (GA) on outcomes in patients undergoing endovascular treatment for acute ischemic stroke (AIS) remains unclear. This study aimed to identify modifiable factors associated with favorable outcomes in patients receiving GA. Electronic medical records of 181 patients treated between 2017 and 2022 were reviewed. The primary outcome measure was the modified Rankin Scale (mRS) score, with scores 0–2 indicating good outcomes and scores 3–6 indicating poor outcomes. Of the 181 patients, 112 were included for mRS score analysis. The mean age was 69 ± 16 years, with an equal gender distribution (55 males and 57 females). Twenty-seven patients (24%) achieved good outcomes. Higher end-tidal CO2 (ETCO2) levels independently predicted good outcomes (odds ratio [OR] 3.75; confidence interval [CI] 1.3–10.58, p = 0.017). Medication choice, including type of volatile anesthetic, maintenance agent, and use of vasoactive medication, did not significantly affect patient outcomes. In conclusion, our study highlights the significance of ventilation management, particularly the maintenance of higher end-tidal CO2 levels, in patients undergoing general anesthesia for endovascular treatment of acute ischemic stroke. This finding underscores the potential for optimizing intraoperative ventilation strategies to enhance patient outcomes in this population. Furthermore, our analysis did not reveal a significant impact of medication choice, both during the induction and maintenance phases of anesthesia, on patient outcomes, suggesting that other factors may play a more prominent role in determining post-procedural functional status.

Disclosures S. Deschner: None. J. Haggard: None. J. Frank: None. M. Al-Kawaz: None. K. Pennypacker: None. A. Trout: None. A. Stowe: None. D. Dornbos: None. S. Pahwa: None. J. Fraser: None.

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