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Association of Anesthetic Exposure Time With Clinical Outcomes After Endovascular Therapy for Acute Ischemic Stroke

Background: The optimal sedative regimen with general anesthesia (GA) or conscious sedation for patients undergoing endovascular therapy (EVT) remains controversial. Apart from sedative regimen, the duration of anesthetic exposure may affect clinical outcomes. We aimed to determine whether there is...

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Autores principales: Raming, Lorenz, Moustafa, Haidar, Prakapenia, Alexandra, Barlinn, Jessica, Gerber, Johannes, Theilen, Hermann, Siepmann, Timo, Pallesen, Lars-Peder, Haedrich, Kevin, Winzer, Simon, Reichmann, Heinz, Linn, Jennifer, Puetz, Volker, Barlinn, Kristian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607856/
https://www.ncbi.nlm.nih.gov/pubmed/31297082
http://dx.doi.org/10.3389/fneur.2019.00679
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author Raming, Lorenz
Moustafa, Haidar
Prakapenia, Alexandra
Barlinn, Jessica
Gerber, Johannes
Theilen, Hermann
Siepmann, Timo
Pallesen, Lars-Peder
Haedrich, Kevin
Winzer, Simon
Reichmann, Heinz
Linn, Jennifer
Puetz, Volker
Barlinn, Kristian
author_facet Raming, Lorenz
Moustafa, Haidar
Prakapenia, Alexandra
Barlinn, Jessica
Gerber, Johannes
Theilen, Hermann
Siepmann, Timo
Pallesen, Lars-Peder
Haedrich, Kevin
Winzer, Simon
Reichmann, Heinz
Linn, Jennifer
Puetz, Volker
Barlinn, Kristian
author_sort Raming, Lorenz
collection PubMed
description Background: The optimal sedative regimen with general anesthesia (GA) or conscious sedation for patients undergoing endovascular therapy (EVT) remains controversial. Apart from sedative regimen, the duration of anesthetic exposure may affect clinical outcomes. We aimed to determine whether there is an association between anesthetic exposure time and clinical outcomes in mechanically ventilated stroke patients undergoing EVT for large vessel occlusion. Methods: This was an observational study of consecutive ischemic stroke patients who underwent EVT for anterior circulation large vessel occlusion under GA from January 2016 to March 2018. To minimize confounding by indication, we restricted our analysis to patients whose anesthetic exposure lasted <72 h. Multivariable logistic regression modeling adjusted for covariates was employed to evaluate whether 90-days independent functional outcome (defined as modified Rankin Scale scores 0–2) and 90-days survival could be predicted by anesthetic exposure time. Results: During the study period, 138 patients with ischemic stroke who underwent EVT received GA and fulfilled our study criteria: median age was 77 years (interquartile range, 65–82); 46.4% were men; median NIHSS score was 18 (15–21), median ASPECT score was 7 (6–8). Median duration of GA was 5.4 (2.5–19.7) h. Logistic regression modeling revealed an independent association between duration of anesthetic exposure and both 90-days independent functional outcome (p = 0.034) and 90-days survival (p = 0.011). Each additional 15-min of anesthetic exposure decreased the likelihood of achieving an independent functional outcome at 90 days by 1.5% and of being alive at 90 days by 1.0%. Conclusion: Our data promotes the notion that ischemic stroke patients who require peri-interventional GA for EVT should be extubated as soon as possible after the procedure.
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spelling pubmed-66078562019-07-11 Association of Anesthetic Exposure Time With Clinical Outcomes After Endovascular Therapy for Acute Ischemic Stroke Raming, Lorenz Moustafa, Haidar Prakapenia, Alexandra Barlinn, Jessica Gerber, Johannes Theilen, Hermann Siepmann, Timo Pallesen, Lars-Peder Haedrich, Kevin Winzer, Simon Reichmann, Heinz Linn, Jennifer Puetz, Volker Barlinn, Kristian Front Neurol Neurology Background: The optimal sedative regimen with general anesthesia (GA) or conscious sedation for patients undergoing endovascular therapy (EVT) remains controversial. Apart from sedative regimen, the duration of anesthetic exposure may affect clinical outcomes. We aimed to determine whether there is an association between anesthetic exposure time and clinical outcomes in mechanically ventilated stroke patients undergoing EVT for large vessel occlusion. Methods: This was an observational study of consecutive ischemic stroke patients who underwent EVT for anterior circulation large vessel occlusion under GA from January 2016 to March 2018. To minimize confounding by indication, we restricted our analysis to patients whose anesthetic exposure lasted <72 h. Multivariable logistic regression modeling adjusted for covariates was employed to evaluate whether 90-days independent functional outcome (defined as modified Rankin Scale scores 0–2) and 90-days survival could be predicted by anesthetic exposure time. Results: During the study period, 138 patients with ischemic stroke who underwent EVT received GA and fulfilled our study criteria: median age was 77 years (interquartile range, 65–82); 46.4% were men; median NIHSS score was 18 (15–21), median ASPECT score was 7 (6–8). Median duration of GA was 5.4 (2.5–19.7) h. Logistic regression modeling revealed an independent association between duration of anesthetic exposure and both 90-days independent functional outcome (p = 0.034) and 90-days survival (p = 0.011). Each additional 15-min of anesthetic exposure decreased the likelihood of achieving an independent functional outcome at 90 days by 1.5% and of being alive at 90 days by 1.0%. Conclusion: Our data promotes the notion that ischemic stroke patients who require peri-interventional GA for EVT should be extubated as soon as possible after the procedure. Frontiers Media S.A. 2019-06-26 /pmc/articles/PMC6607856/ /pubmed/31297082 http://dx.doi.org/10.3389/fneur.2019.00679 Text en Copyright © 2019 Raming, Moustafa, Prakapenia, Barlinn, Gerber, Theilen, Siepmann, Pallesen, Haedrich, Winzer, Reichmann, Linn, Puetz and Barlinn. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Raming, Lorenz
Moustafa, Haidar
Prakapenia, Alexandra
Barlinn, Jessica
Gerber, Johannes
Theilen, Hermann
Siepmann, Timo
Pallesen, Lars-Peder
Haedrich, Kevin
Winzer, Simon
Reichmann, Heinz
Linn, Jennifer
Puetz, Volker
Barlinn, Kristian
Association of Anesthetic Exposure Time With Clinical Outcomes After Endovascular Therapy for Acute Ischemic Stroke
title Association of Anesthetic Exposure Time With Clinical Outcomes After Endovascular Therapy for Acute Ischemic Stroke
title_full Association of Anesthetic Exposure Time With Clinical Outcomes After Endovascular Therapy for Acute Ischemic Stroke
title_fullStr Association of Anesthetic Exposure Time With Clinical Outcomes After Endovascular Therapy for Acute Ischemic Stroke
title_full_unstemmed Association of Anesthetic Exposure Time With Clinical Outcomes After Endovascular Therapy for Acute Ischemic Stroke
title_short Association of Anesthetic Exposure Time With Clinical Outcomes After Endovascular Therapy for Acute Ischemic Stroke
title_sort association of anesthetic exposure time with clinical outcomes after endovascular therapy for acute ischemic stroke
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6607856/
https://www.ncbi.nlm.nih.gov/pubmed/31297082
http://dx.doi.org/10.3389/fneur.2019.00679
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