Original ArticleCirculatory and Respiratory Parameters during Acute Endovascular Stroke Therapy in Conscious Sedation or General Anesthesia
Section snippets
Methods
Ethical approval was obtained and informed consent was waived by the local ethics committee of the University of Heidelberg (reference number S-189/2013).
GA for endovascular stroke treatment has been a standard practice in our institution for years. Intubation was performed in the neurointensive care unit by a neurointensivist and experienced nursing staff. We used intravenous (IV) etomidate (20 mg, in rare cases with insufficient sedation 40 mg) for sedation, IV fentanyl (.2-.3 mg) for
Results
Altogether, 44 patients were included, 29 patients were treated under GA, 15 under CS. Two patients had to be switched from CS to GA because of agitation and could then be managed without complications. Age and percentage of female patients were similar between the 2 groups. Of the patients with left hemispheric stroke, 16 (59%) were treated under GA. Seven patients of those with right hemispheric stroke (70%) were treated under GA. This difference was not statistically significant (P = .8). In
Discussion
To our knowledge, this study is the first to prospectively compare neuroanesthesiological management and particularly circulatory and pulmonary parameters between AIS patients treated under CS or GA for endovascular recanalization. We found that patients under CS as compared with GA (1) have a significantly higher average SBP and a lower vasopressor requirement; (2) have a lower average etCO2; and (3) do not differ significantly with regard to cerebral oximetry.
The lower concentrations of
References (36)
- et al.
Blood pressure as a prognostic factor after acute stroke
Lancet Neurol
(2009) Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension
Lancet
(2010)- et al.
Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension
Lancet
(2010) - et al.
The value of near-infrared spectroscopy measured cerebral oximetry during carotid endarterectomy in perioperative stroke prevention. A review
Eur J Vasc Endovasc Surg
(2009) - et al.
Endovascular therapy after intravenous t-PA versus t-PA alone for stroke
N Engl J Med
(2013) - et al.
Endovascular treatment for acute ischemic stroke
N Engl J Med
(2013) - et al.
A trial of imaging selection and endovascular treatment for ischemic stroke
N Engl J Med
(2013) - et al.
A randomized trial of intraarterial treatment for acute ischemic stroke
N Engl J Med
(2015) Local is better than general anesthesia during endovascular acute stroke interventions
Stroke
(2010)- et al.
General is better than local anesthesia during endovascular procedures
Stroke
(2010)
General or local anesthesia during endovascular procedures: sailing quiet in the darkness or fast under a daylight storm
Stroke
Conscious sedation versus general anesthesia during endovascular therapy for acute anterior circulation stroke: preliminary results from a retrospective, multicenter study
Stroke
North American SOLITAIRE Stent-Retriever Acute Stroke Registry: choice of anesthesia and outcomes
Stroke
Anesthesia for endovascular treatment of acute ischemic stroke
Neurology
Comparison of safety and clinical and radiographic outcomes in endovascular acute stroke therapy for proximal middle cerebral artery occlusion with intubation and general anesthesia versus the nonintubated state
Stroke
Anesthesia and sedation practices among neurointerventionalists during acute ischemic stroke endovascular therapy
Front Neurol
Conscious sedation versus general anaesthesia during mechanical thrombectomy for stroke: a propensity score analysis
J Neurointerv Surg
Is periprocedural sedation during acute stroke therapy associated with poorer functional outcomes?
J Neurointerv Surg
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This study did not receive any financial support.
All the authors declare that they have no conflict of interest with regard to this study.