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Hemodynamic Management of Patients During Endovascular Treatment of Acute Ischemic Stroke Under Conscious Sedation: A Retrospective Cohort Study
- Source :
- Journal of neurosurgical anesthesiology. 31(3)
- Publication Year :
- 2018
-
Abstract
- 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.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 for15 minutes despite hemodynamic intervention. We performed regression analysis to determine the predictors of hemodynamic intervention and poor hemodynamic control.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 was140 mm Hg in 30.2% of the patients and180 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; P0.001). In-hospital mortality was 13.6%.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.
- Subjects :
- Male
Sedation
medicine.medical_treatment
Conscious Sedation
Hemodynamics
Blood Pressure
Revascularization
Brain Ischemia
Cohort Studies
03 medical and health sciences
0302 clinical medicine
030202 anesthesiology
medicine
Humans
Acute ischemic stroke
Aged
Retrospective Studies
Aged, 80 and over
Intraoperative Care
business.industry
Endovascular Procedures
Retrospective cohort study
Anesthesiologists
Stroke
Anesthesiology and Pain Medicine
Blood pressure
Treatment Outcome
Anesthesia
Anesthetic
Surgery
Female
Neurology (clinical)
medicine.symptom
business
030217 neurology & neurosurgery
Cohort study
medicine.drug
Subjects
Details
- ISSN :
- 15371921
- Volume :
- 31
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- Journal of neurosurgical anesthesiology
- Accession number :
- edsair.doi.dedup.....8b2c824d78c75aa20f312284f30fce5a