Seby John1, Jaspreet Somal2, Umera Thebo3, Muhammad S Hussain4, Ehab Farag2, Suzanne Dupler2, Joao Gomes4. 1. Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio. Electronic address: johns@ccf.org. 2. Department of General Anesthesia, Cleveland Clinic, Cleveland, Ohio. 3. Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio. 4. Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: There is limited data on the safety, hemodynamic profile, and outcome of patients undergoing intra-arterial therapy (IAT) for acute ischemic stroke (AIS) under sedation with dexmedetomidine (DEX) versus propofol (PROP). METHODS: Retrospective study of patients with anterior circulation AIS, who underwent IAT without intubation, and received either DEX or PROP between January 2008 and December 2012, was performed. Demographics, stroke treatments, time metrics, anesthesia, intraprocedural hemodynamics, vasopressor use, infarct volumes, recanalization status, and intracerebral hemorrhage were collected. RESULTS: Seventy-two patients met inclusion criteria, of which 35 received DEX and 37 PROP. There was no difference in baseline demographics, stroke treatments, successful recanalization, hemorrhages, infarct volume growth, good clinical outcome (mRS ≤ 2 [19% versus 22%, P = .742]), or in-hospital mortality (18% versus 8%, P = .225) between DEX and PROP. The DEX group had lower intraprocedural minimum systolic blood pressure (103 ± 27 versus 114 ± 18 mm Hg, P = .032) and minimum mean arterial pressure (MAP; 67 ± 17 versus 77 ± 10 mm Hg, P = .006). More patients in the DEX group experienced episodes of hypotension (MAP < 60 mm Hg; 24% versus 3%; P = .010) and had higher vasopressor requirement (phenylephrine: 1825 ± 2390 versus 491 ± 884 mcg, P = .007) compared to PROP. CONCLUSIONS: There was no difference in good clinical outcome or in-hospital mortality in patients undergoing IAT for AIS using DEX versus PROP sedation. However, hemodynamic instability and vasopressor requirement were significantly higher in the DEX group. DEX should be cautiously utilized in IAT.
BACKGROUND: There is limited data on the safety, hemodynamic profile, and outcome of patients undergoing intra-arterial therapy (IAT) for acute ischemic stroke (AIS) under sedation with dexmedetomidine (DEX) versus propofol (PROP). METHODS: Retrospective study of patients with anterior circulation AIS, who underwent IAT without intubation, and received either DEX or PROP between January 2008 and December 2012, was performed. Demographics, stroke treatments, time metrics, anesthesia, intraprocedural hemodynamics, vasopressor use, infarct volumes, recanalization status, and intracerebral hemorrhage were collected. RESULTS: Seventy-two patients met inclusion criteria, of which 35 received DEX and 37 PROP. There was no difference in baseline demographics, stroke treatments, successful recanalization, hemorrhages, infarct volume growth, good clinical outcome (mRS ≤ 2 [19% versus 22%, P = .742]), or in-hospital mortality (18% versus 8%, P = .225) between DEX and PROP. The DEX group had lower intraprocedural minimum systolic blood pressure (103 ± 27 versus 114 ± 18 mm Hg, P = .032) and minimum mean arterial pressure (MAP; 67 ± 17 versus 77 ± 10 mm Hg, P = .006). More patients in the DEX group experienced episodes of hypotension (MAP < 60 mm Hg; 24% versus 3%; P = .010) and had higher vasopressor requirement (phenylephrine: 1825 ± 2390 versus 491 ± 884 mcg, P = .007) compared to PROP. CONCLUSIONS: There was no difference in good clinical outcome or in-hospital mortality in patients undergoing IAT for AIS using DEX versus PROP sedation. However, hemodynamic instability and vasopressor requirement were significantly higher in the DEX group. DEX should be cautiously utilized in IAT.
Authors: Davide Simonato; Mario Ganau; Paolo Feltracco; Francesco Causin; Marina Munari; Andrea Bortolato Journal: Childs Nerv Syst Date: 2020-08-27 Impact factor: 1.475