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Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms
Background: Delayed cerebral ischemia and cerebral vasospasm remain the leading causes of poor outcome in survivors of aneurysmal subarachnoid hemorrhage. Refractory cerebral vasospasms can be treated with endovascular vasodilator therapy, which can either be performed in conscious sedation or gener...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
F1000 Research Limited
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356260/ https://www.ncbi.nlm.nih.gov/pubmed/34394915 http://dx.doi.org/10.12688/f1000research.52324.2 |
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author | Fischer, Corinne Vulcu, Sonja Goldberg, Johannes Wagner, Franca Rodriguez, Belén Söll, Nicole Mordasini, Pasquale Haenggi, Matthias Schefold, Joerg C. Raabe, Andreas Z'Graggen, Werner J. |
author_facet | Fischer, Corinne Vulcu, Sonja Goldberg, Johannes Wagner, Franca Rodriguez, Belén Söll, Nicole Mordasini, Pasquale Haenggi, Matthias Schefold, Joerg C. Raabe, Andreas Z'Graggen, Werner J. |
author_sort | Fischer, Corinne |
collection | PubMed |
description | Background: Delayed cerebral ischemia and cerebral vasospasm remain the leading causes of poor outcome in survivors of aneurysmal subarachnoid hemorrhage. Refractory cerebral vasospasms can be treated with endovascular vasodilator therapy, which can either be performed in conscious sedation or general anesthesia. The aim of this study is to compare the effect of the anesthesia modality on long-term clinical outcomes in patients undergoing endovascular vasodilator therapy due to cerebral vasospasm and hypoperfusion. Methods: Modified Rankin Scale (mRS) scores were retrospectively analyzed at time of discharge from the hospital and six months after aneurysmal subarachnoid hemorrhage. Additionally, National Institutes of Health Stroke Scale (NIHSS) was assessed 24 hours before, immediately before, immediately after, and 24 hours after endovascular vasodilator therapy, and at discharge and six months. Interventional parameters such as duration of intervention, choice and dosage of vasodilator and number of arteries treated were also recorded. Results: A total of 98 patients were included in this analysis and separated into patients who had interventions in conscious sedation, general anesthesia and a mix of both. Neither mRS at discharge nor at six months showed a significant difference for functionally independent outcomes (mRS 0-2) between groups. NIHSS before endovascular vasodilator therapy was significantly higher in patients receiving interventions in general anesthesia but did not differ anymore between groups six months after the initial bleed. Conclusion: This study did not observe a difference in outcome whether patients underwent endovascular vasodilator therapy in general anesthesia or conscious sedation for refractory cerebral vasospasms. Hence, the choice should be made for each patient individually. |
format | Online Article Text |
id | pubmed-8356260 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | F1000 Research Limited |
record_format | MEDLINE/PubMed |
spelling | pubmed-83562602021-08-12 Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms Fischer, Corinne Vulcu, Sonja Goldberg, Johannes Wagner, Franca Rodriguez, Belén Söll, Nicole Mordasini, Pasquale Haenggi, Matthias Schefold, Joerg C. Raabe, Andreas Z'Graggen, Werner J. F1000Res Research Article Background: Delayed cerebral ischemia and cerebral vasospasm remain the leading causes of poor outcome in survivors of aneurysmal subarachnoid hemorrhage. Refractory cerebral vasospasms can be treated with endovascular vasodilator therapy, which can either be performed in conscious sedation or general anesthesia. The aim of this study is to compare the effect of the anesthesia modality on long-term clinical outcomes in patients undergoing endovascular vasodilator therapy due to cerebral vasospasm and hypoperfusion. Methods: Modified Rankin Scale (mRS) scores were retrospectively analyzed at time of discharge from the hospital and six months after aneurysmal subarachnoid hemorrhage. Additionally, National Institutes of Health Stroke Scale (NIHSS) was assessed 24 hours before, immediately before, immediately after, and 24 hours after endovascular vasodilator therapy, and at discharge and six months. Interventional parameters such as duration of intervention, choice and dosage of vasodilator and number of arteries treated were also recorded. Results: A total of 98 patients were included in this analysis and separated into patients who had interventions in conscious sedation, general anesthesia and a mix of both. Neither mRS at discharge nor at six months showed a significant difference for functionally independent outcomes (mRS 0-2) between groups. NIHSS before endovascular vasodilator therapy was significantly higher in patients receiving interventions in general anesthesia but did not differ anymore between groups six months after the initial bleed. Conclusion: This study did not observe a difference in outcome whether patients underwent endovascular vasodilator therapy in general anesthesia or conscious sedation for refractory cerebral vasospasms. Hence, the choice should be made for each patient individually. F1000 Research Limited 2021-08-02 /pmc/articles/PMC8356260/ /pubmed/34394915 http://dx.doi.org/10.12688/f1000research.52324.2 Text en Copyright: © 2021 Fischer C et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Fischer, Corinne Vulcu, Sonja Goldberg, Johannes Wagner, Franca Rodriguez, Belén Söll, Nicole Mordasini, Pasquale Haenggi, Matthias Schefold, Joerg C. Raabe, Andreas Z'Graggen, Werner J. Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms |
title | Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms |
title_full | Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms |
title_fullStr | Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms |
title_full_unstemmed | Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms |
title_short | Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms |
title_sort | anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8356260/ https://www.ncbi.nlm.nih.gov/pubmed/34394915 http://dx.doi.org/10.12688/f1000research.52324.2 |
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