Blood pressure behavior during mechanical thrombectomy and drugs used for conscious sedation or general anesthesia

ABSTRACT Background: The optimal blood pressure (BP) during mechanical thrombectomy for acute ischemic stroke is currently unclear. Objective: To investigate BP behavior during mechanical thrombectomy in patients with acute ischemic stroke and its relationship with drugs used for sedation or general anesthesia. Additionally, we investigated the association between BP oscillation during mechanical thrombectomy and recanalization status, and with functional outcome at discharge. Methods: Consecutive patients treated with mechanical thrombectomy for acute ischemic stroke were evaluated in a tertiary hospital from December/2009 to December/2015. Maximum, minimum, and mean systolic and diastolic BP, and mean arterial pressures were collected during the procedure. Sedative drugs were also reviewed. Results: Fifty-three patients with a mean age of 71.9 years (60.4% men) were treated with mechanical thrombectomy. The mean reduction in systolic BP and mean arterial pressure from hospital admission to mechanical thrombectomy were respectively 42 and 36 mmHg. During the procedure, oscillations were 50.4 mmHg for systolic, and 33.2 mmHg for diastolic BP. Patients treated with neuromuscular blocking drugs had more oscillation in systolic BP from hospital admission to procedure (51.1 versus 26.2 mmHg, P=0.06). The use of cisatracurium (43.9 versus 29.6 mmHg, P=0.02) and succinylcholine (44.7 versus 29.3 mmHg, P=0.01) were associated with a significant drop in BP during the procedure. Conclusions: Significant BP oscillation occurs during mechanical thrombectomy. Drugs used for conscious sedation or general anesthesia, specifically neuromuscular blocking agents, might have an influence upon BP levels.

Download Full-text

General anesthesia versus conscious sedation in mechanical thrombectomy for acute ischemic stroke

Journal of the Neurological Sciences ◽

10.1016/j.jns.2019.10.726 ◽

2019 ◽

Vol 405 ◽

pp. 150-151

Author(s):

M. Pishjoo ◽

F. Fazeli ◽

M. Hashemi ◽

M. Javdani Yekta ◽

M. Mashhadinejad ◽

...

Keyword(s):

Ischemic Stroke ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Conscious Sedation

Download Full-text

Abstract WP2: Anesthesia Technique and Outcomes of Mechanical Thrombectomy in Patients With Acute Ischemic Stroke

Stroke ◽

10.1161/str.48.suppl_1.wp2 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Kimon Bekelis ◽

Symeon Missios ◽

Todd MacKenzie ◽

Stavropoula Tjoumakaris ◽

Pascal Jabbour

Keyword(s):

New York ◽

Ischemic Stroke ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Instrumental Variable ◽

Mechanical Thrombectomy ◽

Conscious Sedation ◽

Case Fatality ◽

Anesthesia Technique ◽

The Impact

Background: The impact of anesthesia technique on the outcomes of mechanical thrombectomy for acute ischemic stroke remains an issue of debate, and has not been studied in clinical trials. We investigated the association of general anesthesia with outcomes in patients undergoing mechanical thrombectomy for ischemic stroke. Methods: We performed a cohort study involving patients undergoing mechanical thrombectomy for ischemic stroke from 2009-2013, who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database. An instrumental variable (hospital rate of general anesthesia) analysis was used to simulate the effects of randomization and investigate the association of anesthesia technique with case-fatality and length of stay (LOS). Results: Of the 1,308 patients undergoing mechanical thrombectomy for acute ischemic stroke, 492 (37.6%) underwent general anesthesia, and 816 (62.4%) underwent conscious sedation. Employing an instrumental variable analysis, we identified that general anesthesia was associated with a 6.4% increased case-fatality (95% CI, 1.9% to 11.0%), and 8.4 days longer LOS (95% CI, 2.9 to 14.0) in comparison to conscious sedation. This corresponded to 15 patients needing to be treated with conscious sedation to prevent one death. Our results were robust in a sensitivity analysis utilizing mixed effects regression, and propensity score adjusted regression models. Conclusions: Using a comprehensive all-payer cohort of acute ischemic stroke patients undergoing mechanical thrombectomy in New York State, we identified an association of general anesthesia with increased case fatality and LOS. These considerations should be taken into account when standardizing acute stroke care.

Download Full-text

Hemodynamics during anesthesia for intra-arterial therapy of acute ischemic stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011867 ◽

2015 ◽

Vol 8 (9) ◽

pp. 883-888 ◽

Cited By ~ 45

Author(s):

Manoj Jagani ◽

Waleed Brinjikji ◽

Alejandro A Rabinstein ◽

Jeffrey J Pasternak ◽

David F Kallmes

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Acute Stroke ◽

General Anesthesia ◽

Acute Ischemic Stroke ◽

Conscious Sedation ◽

Demographic Data ◽

Neurological Outcomes ◽

Physiological Variables ◽

Lower Maximum

Background and purposeMany studies have suggested a relationship between the type of anesthesia provided during intra-arterial therapy for acute ischemic stroke and patient outcomes. Variability in blood pressure and hypotension have previously been identified as possible reasons for worse outcomes in acute stroke. Our aim was to investigate hemodynamic parameters and neurological outcomes of patients receiving either general anesthesia or conscious sedation for intra-arterial therapy of acute stroke.MethodsWe performed a retrospective review of patients undergoing intra-arterial therapy from December 2008 to March 2015. Demographic data, baseline National Institutes of Health Stroke Scale score, preoperative physiological variables, procedural details, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate, and modified Rankin Scale scores were recorded.Results99 patients were included in the study, with 38 receiving general anesthesia and 61 receiving conscious sedation. Patients who received general anesthesia had a lower maximum SBP (p=0.02), minimum SBP (p<0.0001), minimum DBP (p<0.0001), and minimum MAP (p<0.0001). On multivariate analysis, general anesthesia was associated with lower minimum SBP (p=0.04), DBP (p=0.02), and MAP (p=0.007). Conscious sedation was associated with more favorable neurological outcomes (p=0.02). Patients with favorable neurological outcomes had a lower maximum variability in SBP (p=0.01) and MAP (p=0.03), as well as a higher minimum DBP (p=0.03).ConclusionsPatients with acute ischemic stroke undergoing intra-arterial therapy with general anesthesia had lower minimum SBP, DBP, and MAP, greater fluctuations in blood pressure, and less favorable outcomes. More studies are needed to examine the implications of variable and reduced blood pressures and neurological outcomes.

Download Full-text