Rate and Prognosis of Patients under Conscious Sedation Requiring Emergent Intubation during Neuroendovascular Procedures

Hassan, Ameer E.; Akbar, Umer; Chaudhry, Saqib A; Tekle, Wondwossen; Tummala, R; Rodriguez, Gutavo J; Qureshi, Adnan I.

doi:10.3174/ajnr.a3385

Cited by 25 publications

(18 citation statements)

References 22 publications

(22 reference statements)

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“…It is worth mentioning that our cohort presented a higher conversion rate from CS to GA compared with previously reported works (13, 23), with nearly 20% (7/36) of GA patients receiving a non-standard anesthetic management with respect to local policy (i.e., CS-policy). Unfortunately, the reasons for these conversions were not recorded, meaning that any deteriorations of the patients who required an emergent intubation cannot be ruled out.…”

Section: Discussionmentioning

confidence: 49%

Impact of Anesthetic Management on Safety and Outcomes Following Mechanical Thrombectomy for Ischemic Stroke in SWIFT PRIME Cohort

et al. 2018

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Background and purpose: The optimal anesthetic management of acute ischemic stroke patients during mechanical thrombectomy (MT) remains controversial. In this post-hoc analysis, we investigated the impact of anesthesia type on clinical outcomes in patients included in SWIFT PRIME trial.Methods: Ninety-seven patients treated with MT were included. Patients treated in centers with general anesthesia (GA) policy (n = 32) were compared with those treated in centers with conscious sedation (CS) policy (n = 65). Primary outcomes studied included times to treatment initiation (TTI), rates of successful recanalization (TICI 2b/3), and functional independence (mRS 0–2 at 90 days). Secondary outcomes were adverse events, lowest systolic and diastolic blood pressures (LSBP and LDBP) during MT. Univariate analysis and multivariate regression logistic modeling were conducted.Results: The GA-policy and CS-policy groups presented comparable TTI (94 ± 36 min vs. 102 ± 48 min; p = 0.44), rates of TICI 2b/3 recanalization (22/32 [68.8%] vs. 51/65 [78.5%]; p = 0.32). CS-policy was associated to higher rate of functional independence than GA-policy, but the difference was not significant (43/65 [66.2%] vs. 16/32 [50.0%]; p = 0.18). GA-policy patients had a higher rate of postoperative pneumonia (11/32 [34.4%] vs. 8/65 [12.3%]; p = 0.02) and lower LSBP (110 [30,160] mmHg vs. 119 [77,170] mmHg; p = 0.03) and LDBP (55 (15,75) mmHg vs. 67 [40,121]; p < 0.001). When corrected for differences in baseline characteristics, GA-policy was associated with lower rate of functional independence (OR 0.32; p = 0.05). A 10-point increase in perprocedural LDBP was associated with an increased likelihood of favorable outcome (OR 1.51; p = 0.01).Conclusions: GA-policy for MT presented comparable TTI and rates of successful revascularization to CS-policy. However, GA-policy was associated with lower rates of functional independence and with higher incidence of perprocedural hypotension and postoperative pneumonia.Clinical Trial Registration: URL—http://www.clinicaltrials.gov. Unique identifier: NCT01657461

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Section: Discussionmentioning

confidence: 49%

Impact of Anesthetic Management on Safety and Outcomes Following Mechanical Thrombectomy for Ischemic Stroke in SWIFT PRIME Cohort

et al. 2018

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“…12,16,25 It is interesting to note that despite these witnessed complications requiring emergent conversion from CS to GA, most centres preferred CS for EVT. This is in good agreement with previous studies which reported a 1.7-14% conversion rate from CS to GA during EVT procedures.…”

Section: Discussionmentioning

confidence: 99%

“…This is in good agreement with previous studies which reported a 1.7-14% conversion rate from CS to GA during EVT procedures. 12,16,25 It is interesting to note that despite these witnessed complications requiring emergent conversion from CS to GA, most centres preferred CS for EVT. Conscious sedation often requires less manpower, is possibly less costly and may be associated with earlier initiation of rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

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

Rasmussen

Simonsen

Sørensen

et al. 2017

Acta Anaesthesiol Scand

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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.

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“…Because patients with more severe strokes were more often intubated and treated under GA, this might directly or indirectly explain their worse outcome, even if severity of illness was mostly corrected for in the studies. The number of studies and patients investigated for CS certainly supports that this may be feasible for EST and that conversion to GA in case of emergency may also be feasible and only rarely (2–14%) necessary . On the basis of the current retrospective data a task force of the Society for Neuroscience in Anesthesiology and Critical Care (SNACC) published a consensus paper on ‘Anesthetic Management of Endovascular Treatment for Acute Ischemic Stroke’.…”

Section: Controversy Of Intubation Vs No Intubation For Estmentioning

confidence: 98%

Sedation vs. Intubation for Endovascular Stroke TreAtment (SIESTA) – A Randomized Monocentric Trial

Schönenberger

Möhlenbruch

Pfaff

et al. 2015

International Journal of Stroke

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Rate and Prognosis of Patients under Conscious Sedation Requiring Emergent Intubation during Neuroendovascular Procedures

Cited by 25 publications

References 22 publications

Impact of Anesthetic Management on Safety and Outcomes Following Mechanical Thrombectomy for Ischemic Stroke in SWIFT PRIME Cohort

Impact of Anesthetic Management on Safety and Outcomes Following Mechanical Thrombectomy for Ischemic Stroke in SWIFT PRIME Cohort

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

Sedation vs. Intubation for Endovascular Stroke TreAtment (SIESTA) – A Randomized Monocentric Trial

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