Sibu Mundiyanapurath1, Silvia Schönenberger2, Maritoni L Rosales3, Ana M Carrilho Romeiro4, Markus Möhlenbruch5, Martin Bendszus5, Werner Hacke2, Julian Bösel2. 1. Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany. Electronic address: sibu.mundiyanapurath@med.uni-heidelberg.de. 2. Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany. 3. Institute for Neuroscience, St. Luke's Medical Center, Boulevard Quezon City, Philippines. 4. Department of Neurology, Hospital S. Bernado, Centro Hospitalar Setúbal, Setúbal, Portugal. 5. Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
Abstract
BACKGROUND: Whether patients suffering from acute ischemic stroke and undergoing endovascular recanalization should be treated under general anesthesia (GA) or conscious sedation (CS) is a matter of debate. According to retrospective studies, GA appears to be associated with a worse outcome than CS. The underlying mechanisms are unknown, but hypotension and hypocapnia during GA have been suggested. There are no prospective data on this question. METHODS: We prospectively analyzed consecutive patients who were treated with endovascular recanalization from 11, 2013 to 03, 2014 regarding blood pressure, end-tidal carbon dioxide (etCO2), cerebral oximetry (by near-infrared spectroscopy), ventilation parameters, response to commands, basic parameters (age, gender, percentage of posterior circulation stroke, National Institutes of Health Stroke Scale score [NIHSSS] on admission, NIHSSS at discharge, rate of successful recanalization [thrombolysis in cerebral infarction scale >2a], duration of intervention, symptom-to-recanalization time, and door-to-needle time), and medication used. RESULTS: Forty-four patients (29 under GA and 15 in CS) were included. Significant differences between the groups (GA versus CS) were found in the median dose of norepinephrine (.4 mg/hour versus .1 mg/hour, P = .003), mean systolic blood pressure (139.67 mm Hg versus 155.00 mm Hg, P = .003), mean duration of relative hypotension (systolic blood pressure <140 mm Hg; 42.75 versus 15 minutes, P = .004), and mean etCO2 values (37.29 mm Hg versus 27.33 mm Hg, P = .004). CONCLUSIONS: In this small prospective study, patients under CS required less vasopressor medication and had a higher mean blood pressure than those under GA, but they also showed signs of hyperventilation. The impact of these physiological differences on outcome needs to be studied in randomized trials.
BACKGROUND: Whether patients suffering from acute ischemic stroke and undergoing endovascular recanalization should be treated under general anesthesia (GA) or conscious sedation (CS) is a matter of debate. According to retrospective studies, GA appears to be associated with a worse outcome than CS. The underlying mechanisms are unknown, but hypotension and hypocapnia during GA have been suggested. There are no prospective data on this question. METHODS: We prospectively analyzed consecutive patients who were treated with endovascular recanalization from 11, 2013 to 03, 2014 regarding blood pressure, end-tidal carbon dioxide (etCO2), cerebral oximetry (by near-infrared spectroscopy), ventilation parameters, response to commands, basic parameters (age, gender, percentage of posterior circulation stroke, National Institutes of Health Stroke Scale score [NIHSSS] on admission, NIHSSS at discharge, rate of successful recanalization [thrombolysis in cerebral infarction scale >2a], duration of intervention, symptom-to-recanalization time, and door-to-needle time), and medication used. RESULTS: Forty-four patients (29 under GA and 15 in CS) were included. Significant differences between the groups (GA versus CS) were found in the median dose of norepinephrine (.4 mg/hour versus .1 mg/hour, P = .003), mean systolic blood pressure (139.67 mm Hg versus 155.00 mm Hg, P = .003), mean duration of relative hypotension (systolic blood pressure <140 mm Hg; 42.75 versus 15 minutes, P = .004), and mean etCO2 values (37.29 mm Hg versus 27.33 mm Hg, P = .004). CONCLUSIONS: In this small prospective study, patients under CS required less vasopressor medication and had a higher mean blood pressure than those under GA, but they also showed signs of hyperventilation. The impact of these physiological differences on outcome needs to be studied in randomized trials.