Tumul Chowdhury1, Alana M Flexman2,3, Melinda Davis4. 1. Toronto Western Hospital, University Health Network, Toronto, ON, Canada. Tumul.Chowdhury@uhn.ca. 2. Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada. 3. Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada. 4. Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Calgary, AB, Canada.
Abstract
PURPOSE: The purpose of this Continuing Professional Development module is to provide information pertaining to anesthetic considerations and management of endovascular thrombectomy (EVT) for patients with acute ischemic stroke. PRINCIPAL FINDINGS: Acute ischemic stroke is a devastating neurologic disorder and timely intervention is key to a good neurologic outcome. This article provides an overview of three important concepts: pathophysiology and disease characteristics of acute ischemic stroke, and the procedural and anesthetic aspects of EVT. Key considerations include recognition of stroke symptoms, timing and urgency of intervention, procedural considerations for anesthesiologists, risks and benefits of different anesthetic techniques, and a summary of recent guidelines. In particular, current recommendations for blood pressure management in this setting are reviewed. CONCLUSIONS: Timely intervention for patients with acute ischemic stroke is of utmost importance. Endovascular thrombectomy is a minimally invasive procedure that has evolved over recent decades and improves outcomes for selected patients with ischemic stroke. Anesthesiologists should have a good understanding of potential complications and anesthetic options. Recent randomized trials have shown that both general anesthesia and sedation are associated with good outcomes; the anesthetic approach should be individualized and may vary by institution. Careful monitoring and maintenance of hemodynamic goals are critical, as is effective communication with the multidisciplinary team.
PURPOSE: The purpose of this Continuing Professional Development module is to provide information pertaining to anesthetic considerations and management of endovascular thrombectomy (EVT) for patients with acute ischemic stroke. PRINCIPAL FINDINGS: Acute ischemic stroke is a devastating neurologic disorder and timely intervention is key to a good neurologic outcome. This article provides an overview of three important concepts: pathophysiology and disease characteristics of acute ischemic stroke, and the procedural and anesthetic aspects of EVT. Key considerations include recognition of stroke symptoms, timing and urgency of intervention, procedural considerations for anesthesiologists, risks and benefits of different anesthetic techniques, and a summary of recent guidelines. In particular, current recommendations for blood pressure management in this setting are reviewed. CONCLUSIONS: Timely intervention for patients with acute ischemic stroke is of utmost importance. Endovascular thrombectomy is a minimally invasive procedure that has evolved over recent decades and improves outcomes for selected patients with ischemic stroke. Anesthesiologists should have a good understanding of potential complications and anesthetic options. Recent randomized trials have shown that both general anesthesia and sedation are associated with good outcomes; the anesthetic approach should be individualized and may vary by institution. Careful monitoring and maintenance of hemodynamic goals are critical, as is effective communication with the multidisciplinary team.
Authors: Tasneem F Hasan; Nathaniel Todnem; Neethu Gopal; David A Miller; Sukhwinder S Sandhu; Josephine F Huang; Rabih G Tawk Journal: Curr Cardiol Rep Date: 2019-08-30 Impact factor: 2.931
Authors: Eva A Mistry; Akshitkumar M Mistry; Mohammad Obadah Nakawah; Nicolas K Khattar; Enzo M Fortuny; Aurora S Cruz; Michael T Froehler; Rohan V Chitale; Robert F James; Matthew R Fusco; John J Volpi Journal: J Am Heart Assoc Date: 2017-05-18 Impact factor: 5.501