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Monitored anesthesia care during mechanical thrombectomy for stroke: need for data-driven and individualized decisions.
Nogueira, Raul G; Mohammaden, Mahmoud H; Moran, Timothy P; Whalin, Matthew K; Gershon, Raphael Y; Al-Bayati, Alhamza R R; Ratcliff, Jonathan; Pisani, Leonardo; Liberato, Bernardo; Bhatt, Nirav; Frankel, Michael R; Haussen, Diogo C.
  • Nogueira RG; Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA raul.g.nogueira@emory.edu.
  • Mohammaden MH; Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Moran TP; Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Whalin MK; Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Gershon RY; Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Al-Bayati ARR; Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Ratcliff J; Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
  • Pisani L; Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Liberato B; Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Bhatt N; Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Frankel MR; Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
  • Haussen DC; Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA.
J Neurointerv Surg ; 13(12): 1088-1094, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1043454
Semantic information from SemMedBD (by NLM)
1. Mechanical thrombectomy TREATS Cerebrovascular accident
Subject
Mechanical thrombectomy
Predicate
TREATS
Object
Cerebrovascular accident
2. Anesthesia management TREATS Cerebrovascular accident
Subject
Anesthesia management
Predicate
TREATS
Object
Cerebrovascular accident
3. Anesthesia management TREATS Patients
Subject
Anesthesia management
Predicate
TREATS
Object
Patients
4. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
5. General Anesthesia USES favor
Subject
General Anesthesia
Predicate
USES
Object
favor
6. General Anesthesia TREATS Patients
Subject
General Anesthesia
Predicate
TREATS
Object
Patients
7. Epidermal cGVHD Score 2 COEXISTS_WITH Cerebrovascular accident
Subject
Epidermal cGVHD Score 2
Predicate
COEXISTS_WITH
Object
Cerebrovascular accident
8. Mechanical thrombectomy TREATS Cerebrovascular accident
Subject
Mechanical thrombectomy
Predicate
TREATS
Object
Cerebrovascular accident
9. Anesthesia management TREATS Cerebrovascular accident
Subject
Anesthesia management
Predicate
TREATS
Object
Cerebrovascular accident
10. Anesthesia management TREATS Patients
Subject
Anesthesia management
Predicate
TREATS
Object
Patients
11. Cerebrovascular accident PROCESS_OF Patients
Subject
Cerebrovascular accident
Predicate
PROCESS_OF
Object
Patients
12. General Anesthesia USES favor
Subject
General Anesthesia
Predicate
USES
Object
favor
13. General Anesthesia TREATS Patients
Subject
General Anesthesia
Predicate
TREATS
Object
Patients
14. Epidermal cGVHD Score 2 COEXISTS_WITH Cerebrovascular accident
Subject
Epidermal cGVHD Score 2
Predicate
COEXISTS_WITH
Object
Cerebrovascular accident
ABSTRACT

BACKGROUND:

The optimal anesthesia management for patients with stroke undergoing mechanical thrombectomy (MT) during the COVID-19 pandemic has become a matter of controversy. Some recent guidelines have favored general anesthesia (GA) in patients perceived as high risk for intraprocedural conversion from sedation to GA, including those with dominant hemispheric occlusions/aphasia or baseline National Institutes of Health Stroke Scale (NIHSS) score >15. We aim to identify the rate and predictors of conversion to GA during MT in a high-volume center where monitored anesthesia care (MAC) is the default modality.

METHODS:

A retrospective review of a prospectively maintained MT database from January 2013 to July 2020 was undertaken. Analyses were conducted to identify the predictors of intraprocedural conversion to GA. In addition, we analyzed the GA conversion rates in subgroups of interest.

RESULTS:

Among 1919 MT patients, 1681 (87.6%) started treatment under MAC (median age 65 years (IQR 55-76); baseline NIHSS 16 (IQR 11-21); 48.4% women). Of the 1677 eligible patients, 26 (1.6%) converted to GA including 1.4% (22/1615) with anterior and 6.5% (4/62) with posterior circulation strokes. The only predictor of GA conversion was posterior circulation stroke (OR 4.99, 95% CI 1.67 to 14.96, P=0.004). The conversion rates were numerically higher in right than in left hemispheric occlusions (1.6% vs 1.2%; OR 1.37, 95% CI 0.59 to 3.19, P=0.47) and in milder than in more severe strokes (NIHSS ≤15 vs >15 2% vs 1.2%; OR 0.62, 95% CI 0.28 to 1.36, P=0.23).

CONCLUSIONS:

Our study showed that the overall rate of conversion from MAC to GA during MT was low (1.6%) and, while higher in posterior circulation strokes, it was not predicted by either hemispheric dominance or stroke severity. Caution should be given before changing clinical practice during moments of crisis.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain Ischemia / Stroke / COVID-19 Type of study: Clinical Practice Guide / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Neurointerv Surg Year: 2021 Document Type: Article Affiliation country: Neurintsurg-2020-016732

Full text: Available Collection: International databases Database: MEDLINE Main subject: Brain Ischemia / Stroke / COVID-19 Type of study: Clinical Practice Guide / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male Country/Region as subject: North America Language: English Journal: J Neurointerv Surg Year: 2021 Document Type: Article Affiliation country: Neurintsurg-2020-016732