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ImportanceGeneral anesthesia and procedural sedation are common practice for mechanical thrombectomy in acute ischemic stroke. However, risks and benefits of each strategy are unclear.ObjectiveTo determine whether general anesthesia or procedural sedation for anterior circulation large-vessel occlusion acute ischemic stroke thrombectomy are associated with a difference in periprocedural complications and 3-month functional outcome.Design, Setting, and ParticipantsThis open-label, blinded end point randomized clinical trial was conducted between August 2017 and February 2020, with final follow-up in May 2020, at 10 centers in France.Adults with occlusion of the intracranial internal carotid artery and/or the proximal middle cerebral artery treated with thrombectomy were enrolled.InterventionsPatients were assigned to receive general anesthesia with tracheal intubation (n = 135) or procedural sedation (n = 138).Main Outcomes and MeasuresThe prespecified primary composite outcome was functional independence (a score of 0 to 2 on the modified Rankin Scale, which ranges from 0 [no neurologic disability] to 6 [death]) at 90 days and absence of major periprocedural complications (procedure-related serious adverse events, pneumonia, myocardial infarction, cardiogenic acute pulmonary edema, or malignant stroke) at 7 days.ResultsAmong 273 patients evaluable for the primary outcome in the modified intention-to-treat population, 142 (52.0%) were women, and the mean (SD) age was 71.6 (13.8) years. The primary outcome occurred in 38 of 135 patients (28.2%) assigned to general anesthesia and in 50 of 138 patients (36.2%) assigned to procedural sedation (absolute difference, 8.1 percentage points; 95% CI, −2.3 to 19.1; P = .15). At 90 days, the rate of patients achieving functional independence was 33.3% (45 of 135) with general anesthesia and 39.1% (54 of 138) with procedural sedation (relative risk, 1.18; 95% CI, 0.86-1.61; P = .32). The rate of patients without major periprocedural complications at 7 days was 65.9% (89 of 135) with general anesthesia and 67.4% (93 of 138) with procedural sedation (relative risk, 1.02; 95% CI, 0.86-1.21; P = .80).Conclusions and RelevanceIn patients treated with mechanical thrombectomy for anterior circulation acute ischemic stroke, general anesthesia and procedural sedation were associated with similar rates of functional independence and major periprocedural complications.Trial RegistrationClinicalTrials.gov Identifier: NCT03229148

BackgroundCentral venous catheters play an important role in patient care. Real-time ultrasound-guided subclavian central venous (SCV) cannulation may reduce the incidence of complications and the time between skin penetration and the aspiration of venous blood into the syringe. Ultrasonic diagnosis of catheter misplacement and pneumothorax related to central venous catheterization is rapid and accurate. It is unclear, however, whether ultrasound real-time guidance and examination can reduce procedure times and complication rates when compared with landmark guidance and radiographic examination for SCV catheterization.Methods/DesignThe Subclavian Central Venous Catheters Guidance and Examination by UltraSound (SUBGEUS) study is an investigator-initiated single center, randomized, controlled two-arm trial. Three hundred patients undergoing SCV catheter placement will be randomized to ultrasound real-time guidance and examination or landmark guidance and radiographic examination. The primary outcome is the time between the beginning of the procedure and control of the catheter. Secondary outcomes include the times required for the six components of the total procedure, the occurrence of complications (pneumothorax, hemothorax, or misplacement), failure of the technique and occurrence of central venous catheter infections.DiscussionThe SUBGEUS trial is the first randomized controlled study to investigate whether ultrasound real-time guidance and examination for SCV catheter placement reduces all procedure times and the rate of complications.Trial registrationClinicalTrials.gov Identifier: NCT01888094

Mediterranean hurricanes, or medicanes, are tropical-like cyclones forming once or twice per year over the waters of the Mediterranean Sea. These mesocyclones pose a serious threat to coastal infrastructure and lives because of their strong winds and intense rainfall. Infrasound technology has already been employed to investigate the acoustic signatures of severe weather events, and this study aims at characterizing, for the first time, the infrasound detections that can be related to medicanes. This work also contributes to infrasound source discrimination efforts in the context of the Comprehensive Nuclear-Test-Ban Treaty. We use data from the infrasound station IS48 of the International Monitoring System in Tunisia to investigate the infrasound signatures of mesocyclones using a multi-channel correlation algorithm. We discuss the detections using meteorological fields to assess the presence of stratospheric waveguides favoring propagation. We corroborate the detections by considering other datasets, such as satellite observations, a surface lightning detection network, and products mapping the simulated intensity of the swell. High- and low-frequency detections are evidenced for three medicanes at distances ranging between 250 and 1100 km from the station. Several cases of non-detection are also discussed. While deep convective systems, and mostly lightning within them, seem to be the main source of detections above 1 Hz, hotspots of swell (microbarom) related to the medicanes are evidenced between 0.1 and 0.5 Hz. In the latter case, simulations of microbarom detections are consistent with the observations. Multi-source situations are highlighted, stressing the need for more resilient detection-estimation algorithms. Cloud-to-ground lightning seems not to explain all high-frequency detections, suggesting that additional sources of electrical or dynamical origin may be at play that are related to deep convective systems.

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