1. Blood pressure during endovascular treatment under conscious sedation or local anesthesia
- Author
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Samuels, N., Graaf, R.A. van de, Berg, C.A.T. van den, Nieboer, D., Eralp, I., Treurniet, K.M., Emmer, B.J., Immink, R.V., Majoie, C., Zwam, W.H. van, Bokkers, R.P., Uyttenboogaart, M., Hasselt, B. van, Muhling, J., Burke, J.F., Roozenbeek, B., Lugt, A. van der, Dippel, D.W., Jenniskens, S.F.M., Boogaarts, H.D., Dijk, E.J. van, Lingsma, H.F., Es, A. van, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, Radiology and Nuclear Medicine, ACS - Diabetes & metabolism, Anesthesiology, Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B05 Cerebral small vessel disease, RS: Carim - B06 Imaging, Neurology, Radiology & Nuclear Medicine, and Public Health
- Subjects
Intraoperative Neurophysiological Monitoring ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Conscious Sedation ,Blood Pressure ,THERAPY ,Brain Ischemia ,0302 clinical medicine ,Modified Rankin Scale ,Local anesthesia ,Prospective Studies ,Registries ,ACUTE ISCHEMIC-STROKE ,030212 general & internal medicine ,Prospective cohort study ,Netherlands ,OUTCOMES ,STATEMENT ,Endovascular Procedures ,THROMBECTOMY ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] ,3. Good health ,Anesthesia ,medicine.symptom ,Mean arterial pressure ,Sedation ,Clinical Neurology ,Article ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,EVENTS ,GENERAL-ANESTHESIA ,03 medical and health sciences ,MANAGEMENT ,medicine ,Humans ,Endovascular treatment ,Ischemic Stroke ,INTRAOPERATIVE HYPOTENSION ,business.industry ,Other Research Radboud Institute for Health Sciences [Radboudumc 0] ,Odds ratio ,CARE ,Confidence interval ,Blood pressure ,Anesthetic ,Ischemic stroke ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Anesthesia, Local - Abstract
ObjectiveTo evaluate the role of blood pressure as mediator of the effect of conscious sedation (CS) compared to local anesthesia (LA) on functional outcome after EVT.MethodsPatients treated in MR CLEAN Registry centers with CS or LA as preferred anesthetic approach during EVT for ischemic stroke were analyzed. First, we evaluated the effect of CS on area under the threshold (AUT), relative difference between baseline and lowest procedural mean arterial pressure (∆LMAP) and procedural blood pressure trend, compared to LA. Second, we assessed the association between blood pressure and functional outcome (modified Rankin Scale, mRS) with multivariable regression. Lastly, we evaluated whether blood pressure explained the effect of CS on mRS.ResultsIn 440 patients with available blood pressure data, patients treated under CS (n = 262) had larger AUTs (median 228 vs 23 mm Hg*min), larger ∆LMAP (median 16% vs 6%) and a more negative blood pressure trend (−0.22 vs −0.08 mm Hg/min) compared to LA (n = 178). Larger ∆LMAP and AUTs were associated with worse mRS (adjusted common OR (acOR) per 10%-drop 0.87, 95%CI 0.78–0.97, and acOR per 300 mm Hg*min 0.89, 95%CI 0.82–0.97). Patients treated under CS had worse mRS compared to LA (acOR 0.59, 95%CI 0.40–0.87) and this association remained when adjusting for ∆LMAP and AUT (acOR 0.62, 95%CI0.42–0.92).ConclusionsLarge blood pressure drops are associated with worse functional outcome. However, blood pressure drops do not explain the worse outcomes in the CS group.
- Published
- 2021