Betwixt and between: an idiomatic understanding of anesthesia in stroke intervention

Milburn, James; Fiorella, David; Hirsch, Joshua A

doi:10.1136/jnis-2023-020364

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…A survey of members of the Association for Radiologic and Imaging Nursing found that 20% of respondents preferred having an anesthesia team for sedation management during EVT, 8.6% of respondents were somewhat uncomfortable providing sedation during EVT, and 1.9% were uncomfortable providing sedation; in addition, 8.4% reported that they were not qualified to administer vasoactive infusions 5 . A recent editorial advocated for the involvement of anesthesiologists during all EVT procedures 6 …”

Section: Discussionmentioning

confidence: 99%

Demonstrating the Value of Routine Anesthesiologist Involvement in Acute Stroke Care: A Retrospective Chart Review

McCusker¹,

Chinchilli

Fritch³

et al. 2023

Journal of Neurosurgical Anesthesiology

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Introduction: The value of routine involvement of anesthesiologists during endovascular thrombectomy (EVT) for acute ischemic stroke has not been clearly demonstrated. At some institutions, anesthesiologists are involved only as needed, while at other institutions, anesthesiologists are involved from the beginning for every EVT. Methods: We retrospectively analyzed the workflow, intraprocedural variables and complications, and outcomes in acute ischemic stroke patients undergoing EVT at a comprehensive stroke center after implementation of routine involvement of an anesthesia team and compared this cohort with patients who received care from sedation-trained nurses working under the supervision of neurointerventionalists with the involvement of anesthesiologists on an as-needed basis. Results: Routine involvement of anesthesiologists was associated with improved workflow performance measures, including decreased median door-to-arterial puncture time (68 min; interquartile range (IQR), 15.5–94.5 min vs. 81 min; IQR, 53–104 min; P=0.001), in-room to arterial puncture time (11 min; IQR, 8–14 min vs. 15 min; IQR, 9–21 min; P<0.0001), and procedure time (51 min; IQR, 40–64 min vs. 60 min; IQR, 40–88.5 min; P=0.007). It was also associated with a nonsignificant trend towards lower rates of desaturation events (8.2% vs. 3.4%; P=0.082) and lower rates of conversion to general anesthesia (1.7% vs. 0%; P=0.160). Ninety-day modified Rankin scores were similar regardless of provider type. Conclusion: Implementation of routine involvement of an anesthesia team during EVT was not associated with improved outcomes but was associated with improved efficiency and greater adherence to guidelines-based physiological parameters, supporting the routine involvement of anesthesiologists during EVT.

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Section: Discussionmentioning

confidence: 99%

Demonstrating the Value of Routine Anesthesiologist Involvement in Acute Stroke Care: A Retrospective Chart Review

McCusker¹,

Chinchilli

Fritch³

et al. 2023

Journal of Neurosurgical Anesthesiology

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“…If a hospital’s routine involvement of anesthesiologists during MT resulted in an additional 10 successful reperfusions each year, it could lead to a net monetary benefit of $2 million/year for just that 1 center. Our neurointerventional colleagues have recently proposed that “immediate access to anesthesia” for all stroke interventions should be a new requirement for comprehensive stroke centers 10 . We advocate for a step further and recommend that anesthesiologists should be routinely involved in all MTs from the outset, to enhance quality and safety.…”

mentioning

confidence: 99%

“…Our neurointerventional colleagues have recently proposed that "immediate access to anesthesia" for all stroke interventions should be a new requirement for comprehensive stroke centers. 10 We advocate for a step further and recommend that anesthesiologists should be routinely involved in all MTs from the outset, to enhance quality and safety. It is time for health care systems to answer this call and provide roundthe-clock anesthesia support for MT programs.…”

mentioning

confidence: 99%

Answering the Call: The Case for Anesthesiologist-led Care for All Stroke Thrombectomies

Whalin

Sharma

2023

Journal of Neurosurgical Anesthesiology

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Neurocritical Care Support of Endovascular Mechanical Thrombectomy

Tahsili-Fahadan,

Wang,

et al. 2024

Preprint

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Background Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality, where timely intervention with mechanical thrombectomy (MT) is crucial for restoring cerebral blood flow and improving patient outcomes. This study evaluates the impact of a dedicated Neurocritical Care Rapid Response Team (NCC-RRT) on MT workflow efficiency and patient outcomes. Methods We conducted a prospective analysis of AIS patients undergoing MT at a Comprehensive Stroke Center between January 2021 and December 2023. The study compared two periods: Era 1 (pre-NCC-RRT, January-October 2021) and Era 2 (post-NCC-RRT, December 2021-December 2023). The NCC-RRT was responsible for the expedited transfer, airway management, procedural analgosedation, and hemodynamic support. Key metrics, including door-to-groin-puncture (DTGP) and door-to-recanalization (DTR) times, were analyzed. Results A total of 395 patients were included in the study. The implementation of the NCC-RRT significantly reduced DTGP and DTR times, particularly in patients receiving general anesthesia (GA). The NCC-RRT was associated with a 14.3% reduction in groin-puncture-to-recanalization time and a 26.6% increase in GA utilization. Additionally, significant time reductions were observed in both direct ED presentations and transferred patients. Conclusions The introduction of a dedicated NCC-RRT led to substantial improvements in MT process efficiency, highlighting the critical role of neurocritical care in optimizing stroke treatment and enhancing patient outcomes. This model offers an effective alternative for centers where dedicated neuroanesthesia teams are unavailable.

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Betwixt and between: an idiomatic understanding of anesthesia in stroke intervention

Cited by 3 publications

References 16 publications

Demonstrating the Value of Routine Anesthesiologist Involvement in Acute Stroke Care: A Retrospective Chart Review

Demonstrating the Value of Routine Anesthesiologist Involvement in Acute Stroke Care: A Retrospective Chart Review

Answering the Call: The Case for Anesthesiologist-led Care for All Stroke Thrombectomies

Neurocritical Care Support of Endovascular Mechanical Thrombectomy

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