Anaesthesia practices for endovascular therapy of acute ischaemic stroke: a Nordic survey

Abstract

Background: The optimal method of anaesthesia for endovascular therapy (EVT) in acute ischaemic stroke (AIS) has not been identified. Nordic departments of anaesthesiology may handle EVT cases for AIS differently. The aim of this survey was to describe the current practice patterns of Nordic anaesthesia departments in anaesthetic management of EVT in AIS. Methods: A survey consisting of 13 questions was sent to one qualified individual at all Nordic departments of anaesthesiology who manage anaesthesia for EVT interventions. The individual completed the questionnaire on behalf of their department. Results: Response rate was 100%. The majority of departments (84%) managed all EVT cases at their respective centres. Most departments have institutional guidelines on anaesthetic management (84%) including blood pressure management (63%) and were able to provide a 24-h immediate response to an EVT request (63%). Conscious sedation was favoured by 68% of the departments using a variety of sedation protocols. Propofol and remifentanil was preferred for GA (58%). Emergent conversion to GA due to uncontrolled patient movements or loss of airway was experienced by 82% and 35% of the departments, respectively. Majority of the departments (89%) responded that non-specialist anaesthetists occasionally handle EVT cases. Conclusions: This survey indicates that the majority of Nordic anaesthesia departments who manage anaesthesia for EVT are able to provide immediate 24-h response to an EVT request. Most of these departments have institutional guidelines for EVT anaesthesia and haemodynamic management. Conscious sedation appears to be the preferred method of anaesthetic care.

Effect of Conscious Sedation vs. General Anesthesia on Outcomes in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke: A Prospective Randomized Clinical Trial

“…A Nordic survey found that 84% of medical centers had institutional guidelines on anesthetic management, and 63% were able to provide a 24 h immediate response to an endovascular therapy request. Uncontrolled patient movements (82%) and loss of airway (35%) were still the most common reasons for converting to GA (39,40). Besides, a previous study found that most LVOs in Caucasians are located in proximal blood vessels, and in situ thrombus is much more common in Asians, which is more difficult to recanalize (41).…”

Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke During COVID-19 Pandemic: Consensus Statement From Society for Neuroscience in Anesthesiology & Critical Care (SNACC)

“…[16][17][18] However, there is considerable variability in practice with some institutions routinely using GA, others routinely using MAC, and yet others offering either anesthetic technique. 19,20 Essentially, although many patients receive MAC for EVT, urgent conversion to GA is undesirable especially when COVID-19 is suspected. The current pandemic has significant implications for anesthesiology and perioperative care generally.…”

The anesthetic approach for endovascular recanalization therapy depends on the lesion site in acute ischemic stroke

“…Patient condition is an essential factor for the choice of anesthetic strategy during EVT [ 4 ]. While GA constitutes the preferred anesthetic method in stroke patients with higher disability, unstable vital parameters, hypoventilation, loss of consciousness, and excessive movements, CS is often conducted in cooperative patients and is sometimes the preferred first-line strategy to avoid a delay of EVT [ 6 – 10 , 25 , 26 ].…”