Abstract:
BACKGROUND:Anesthetic modality and hemodynamic management during mechanical thrombectomy (MT) for acute ischemic stroke (AIS) are potential contributors to the success of revascularization. The aims of our study were to review the hemodynamic management by anesthesiologists and clinical outcomes in patients undergoing MT under conscious sedation. METHODS:Retrospective cohort study of patients with anterior circulation AIS from January 2012 to March 2016. Primary outcome was hemodynamic intervention, defined as administration of vasoactive drugs to maintain systolic blood pressure (BP) between 140 and 180 mm Hg. The secondary outcome was poor hemodynamic control, defined as BP outside target for >15 minutes despite hemodynamic intervention. We performed regression analysis to determine the predictors of hemodynamic intervention and poor hemodynamic control. RESULTS:A total of 126 patients were included in this study; 92% (116) receiving conscious sedation and 8% (10) no sedation. Upon arrival to the neuroradiology suite, systolic BP was <140 mm Hg in 30.2% of the patients and >180 mm Hg in 14.3%. Hemodynamic intervention was required in 38.9% of patients; 15.1% for hypotension and 19.8% for hypertension. In the multivariate analysis, systolic BP on hospital admission (odds ratio, 1.02; 95% confidence interval, 1.00-1.04; P=0.019) constituted a predictor for hemodynamic intervention. Poor hemodynamic control occurred in 12.7% of patients, with lower baseline systolic BP being associated with higher risk of intraprocedural hypotension (odds ratio, 0.92; 95% confidence interval, 0.89-0.96; P<0.001). In-hospital mortality was 13.6%. CONCLUSIONS:Hemodynamic intervention is frequent during MT under conscious sedation. The routine presence of anesthesiologists during MT may be helpful in maintaining hemodynamic stability and allow rapid treatment of emergent complications. An individualized approach with tailored hemodynamic targets is required during management of patients undergoing MT for AIS.
journal_name
J Neurosurg Anesthesioljournal_title
Journal of neurosurgical anesthesiologyauthors
Alcaraz G,Chui J,Schaafsma J,Manninen P,Porta-Sánchez A,Pereira VM,Venkatraghavan Ldoi
10.1097/ANA.0000000000000514subject
Has Abstractpub_date
2019-07-01 00:00:00pages
299-305issue
3eissn
0898-4921issn
1537-1921journal_volume
31pub_type
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journal_title:Journal of neurosurgical anesthesiology
pub_type: 临床试验,杂志文章,随机对照试验
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