Anesthesia and Sedation Practices Among Neurointerventionalists during Acute Ischemic Stroke Endovascular Therapy

David L McDonagh, Daiwai M Olson, Junaid S Kalia, Rishi Gupta, Alex Abou-Chebl, Osama O Zaidat, David L McDonagh, Daiwai M Olson, Junaid S Kalia, Rishi Gupta, Alex Abou-Chebl, Osama O Zaidat

Abstract

Background and purpose: Intra-arterial reperfusion therapies are expanding frontiers in acute ischemic stroke (AIS) management but there is considerable variability in clinical practice. The use of general anesthesia (GA) is one example. We aimed to better understand sedation practices in AIS.

Methods: An online survey was distributed to the 68 active members of the Society of Vascular and Interventional Neurology (SVIN). Survey development was based on discussions at the SVIN Endovascular Stroke Round Table Meeting (Chicago, IL, 2008). The final survey contained 12 questions. Questions were developed as single and multiple-item responses; with an option for a free-text response.

Results: There was a 72% survey response rate (N = 49/68). Respondents were interventional neurologists in practice 1-5 years (71.4%, N = 35). The mean (±SD) AIS interventions performed per year at the respondents' institutions was 42.5 ± 25, median 35.0 (IQR 20, 60). The most frequent anesthesia type used was GA (anesthesia team), then conscious sedation (nurse administered), monitored anesthesia care (anesthesia team), and finally local analgesia alone. There was a preference for GA because of eliminating movement (65.3% of respondents; N = 32/49), perceived procedural safety (59.2%, N = 29/49), and improved procedural efficacy (42.9%, N = 21/49). However, cited limitations to GA included risk of time delay (69.4%, N = 34), of propagating cerebral ischemia due to hypoperfusion or other complications (28.6%, N = 14), and lack of adequate anesthesia workforce (20.4%, N = 7).

Conclusions: The most frequent type of anesthesia used by Neurointerventionalists for AIS interventions is GA. Prior to making GA standard of care during AIS intervention, more data are needed about effects on clinical outcomes.

Keywords: acute ischemic stroke; anesthesia; endovascular; intra-arterial; neurointerventional.

Figures

Figure 1
Figure 1
Averaged ratings of physician's frequency of use for four types of anesthesia. *Treated as ordinal where 1 = Never, 2 = Least frequent, 3 = Frequent, 4 = Most frequent.

References

    1. Abou-Chebl A., Krieger D. W., Bajzer C. T., Yadav J. S. (2006). Intracranial angioplasty and stenting in the awake patient. J. Neuroimaging 16, 216–22310.1111/j.1552-6569.2006.00043.x
    1. Abou-Chebl A., Lin R., Hussain M. S., Jovin T. G., Levy E. I., Liebeskind D. S., Yoo A. J., Hsu D. P., Rymer M. M., Tayal A. H., Zaidat O. O., Natarajan S. K., Nogueira R. G., Nanda A., Tian M., Hao Q., Kalia J. S., Nguyen T. N., Chen M., Gupta R. (2010). Conscious sedation versus general anesthesia during endovascular therapy for acute anterior circulation stroke: Preliminary results from a retrospective multi-center study. Stroke 41, 1175–117910.1161/STROKEAHA.109.574129
    1. Alexandrov A. V., Molina C. A., Grotta J. C., Garami Z., Ford S. R., Alvarez-Sabin J., Montaner J., Saqqur M., Demchuk A. M., Moyé L. A., Hill M. D., Wojner A. W.; for the CLOTBUST Investigators (2004). Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N. Engl. J. Med. 351, 2170–217810.1056/NEJMoa041175
    1. American Society of Anesthesiologist Task Force on Preoperative Fasting (1999). Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology 90, 896–90510.1097/00000542-199903000-00034
    1. Furlan A., Higashida R., Wechsler L., Gent M., Rowley H., Kase C., Pessin M., Ahuja A., Callahan F., Clark W. M., Silver F., Rivera F. (1999). Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in acute cerebral thromboembolism. JAMA 282, 2003–201110.1001/jama.282.21.2003
    1. Hemmen T. M., Lyden P. D. (2007). Induced hypothermia for acute stroke. Stroke 38, 794–79910.1161/01.STR.0000247920.15708.fa
    1. Jumaa M. A., Zhang F., Ruiz-Ares G., Gelzinis T., Malik A. M., Aleu A., Oakley J. I., Jankowitz B., Lin R., Reddy V., Zaidi S. F., Hammer M. D., Wechsler L. R., Horowitz M., Jovin T. G. (2010). Comparison of safety and clinical and radiographic outcomes in endovascular acute stroke therapy for proximal middle cerebral artery occlusion with intubation and general anesthesia versus the nonintubated state. Stroke 41, 1180–118410.1161/STROKEAHA.109.574194
    1. Kahn R. A., Moskowitz D. M., Marin M. L., Hollier L. H., Parsons R., Teodorescu V., McLaughlin M. (2000). Safety and efficacy of high-dose adenosine-induced asystole during endovascular AAA repair. J. Endovasc. Ther. 7, 292–296
    1. Lee C. Z., Litt L., Hashimoto T., Young W. L. (2004). Physiologic monitoring and anesthesia considerations in acute ischemic stroke. J. Vasc. Interv. Radiol. 15, S13–S19
    1. Martino R., Foley N., Bhogal S., Diamant N., Speechley M., Teasell R. (2005). Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 36, 2756–276310.1161/01.STR.0000190056.76543.eb
    1. Mazighi M., Serfaty J. M., Labreuche J., Laissy J. P., Meseguer E., Lavallée P. C., Cabrejo L., Slaoui T., Guidoux C., Lapergue B., Klein I. F., Olivot J. M., Raphaeli G., Gohin C., Claeys E. S., Amarenco P; RECANALISE investigators (2009). Comparison of intravenous alteplase with a combined intravenous–endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study. Lancet Neurol. 8, 802–80910.1016/S1474-4422(09)70182-6
    1. McDermott V. G., Chapman M. E., Gillespie I. (1993). Sedation and patient monitoring in vascular and interventional radiology. Br. J. Radiol. 66, 667–671
    1. Mueller P. R., Wittenberg K. H., Kaufman J. A., Lee M. J. (1997). Patterns of anesthesia and nursing care for interventional radiology procedures: a national survey of physician practices and preferences. Radiology 202, 339–343
    1. Nichols C., Carrozzella J., Yeatts S., Tomsick T., Broderick J., Khatri P. (2010). Is periprocedural sedation during acute stroke therapy associated with poorer functional outcomes? J. Neurointerv. Surg. 2, 67–70
    1. Qureshi A. I., Suri M. F., Khan J., Kim S. H., Fessler R. D., Ringer A. J., Guterman L. R., Hopkins L. N. (2001). Endovascular treatment of intracranial aneurysms by using Guglielmi detachable coils in awake patients: safety and feasibility. J. Neurosurg. 94, 880–88510.3171/jns.2001.94.6.0880
    1. Smith W. S., Sung G., Saver J., Budzik R., Duckwiler G., Liebeskind D. S., Lutsep H. L., Rymer M. M., Higashida R. T., Starkman S., Gobin Y. P., ; for the Multi MERCI Investigators (2008). Mechanical thrombectomy for acute ischemic stroke: final results of the multi MERCI trial. Stroke 38, 1205–1212
    1. Smith W. S., Sung G., Starkman S., Saver J. L., Kidwell C. S., Gobin Y. P., Lutsep H. L., Nesbit G. M., Grobelny T., Rymer M. M., Silverman I. E., Higashida R. T., Budzik R. F., Marks M. P.; for the MERCI Trial Investigators (2005). Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 36, 1432–1438
    1. Young W. L. (2007). Anesthesia for endovascular neurosurgery and interventional neuroradiology. Anesthesiol. Clin. 25, 391–412

Source: PubMed

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