Cargando…

Anesthetic management of endovascular treatment for acute ischemic stroke: Influences on outcome and complications

BACKGROUND AND OBJECTIVES: The emerging use of endovascular therapies for acute ischemic stroke, like intra-arterial thrombectomy, compels a better understanding of the anesthetic management required and its impact in global outcomes. This article reviews the available data on the anesthetic managem...

Descripción completa

Detalles Bibliográficos
Autores principales: Tinoco, Catarina Sousa Laranjo, Santos, Patrícia Marlene Carvalho dos
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9391700/
https://www.ncbi.nlm.nih.gov/pubmed/30195628
http://dx.doi.org/10.1016/j.bjane.2018.06.003
_version_ 1784770906760937472
author Tinoco, Catarina Sousa Laranjo
Santos, Patrícia Marlene Carvalho dos
author_facet Tinoco, Catarina Sousa Laranjo
Santos, Patrícia Marlene Carvalho dos
author_sort Tinoco, Catarina Sousa Laranjo
collection PubMed
description BACKGROUND AND OBJECTIVES: The emerging use of endovascular therapies for acute ischemic stroke, like intra-arterial thrombectomy, compels a better understanding of the anesthetic management required and its impact in global outcomes. This article reviews the available data on the anesthetic management of endovascular treatment, comparing general anesthesia with conscious sedation, the most used modalities, in terms of anesthetic induction and procedure duration, patient mobility, occlusion location, hemodynamic parameters, outcome and safety; it also focuses on the state-of-the-art on physiologic and pharmacologic neuroprotection. CONTENTS: Most of the evidence on this topic is retrospective and contradictory, with only three small randomized studies to date. Conscious sedation was frequently associated with better outcomes, but the prospective evidence declared that it has no advantage over general anesthesia concerning that issue. Conscious sedation is at least as safe as general anesthesia for the endovascular treatment of acute ischemic stroke, with equivalent mortality and fewer complications like pneumonia, hypotension or extubation difficulties. It has, however, a higher frequency of patient agitation and movement, which is the main cause for conversion to general anesthesia. CONCLUSIONS: General anesthesia and conscious sedation are both safe alternatives for anesthetic management of patients submitted to endovascular thrombectomy. No anesthetic management is universally recommended and hopefully the ongoing randomized clinical trials will shed some light on the best approach; meanwhile, the choice of anesthesia should be based on the patient's individual characteristics. Regarding neuroprotection, hemodynamic stability is currently the most important strategy, as no pharmacological method has been proven effective in humans.
format Online
Article
Text
id pubmed-9391700
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-93917002022-08-21 Anesthetic management of endovascular treatment for acute ischemic stroke: Influences on outcome and complications Tinoco, Catarina Sousa Laranjo Santos, Patrícia Marlene Carvalho dos Braz J Anesthesiol Review Article BACKGROUND AND OBJECTIVES: The emerging use of endovascular therapies for acute ischemic stroke, like intra-arterial thrombectomy, compels a better understanding of the anesthetic management required and its impact in global outcomes. This article reviews the available data on the anesthetic management of endovascular treatment, comparing general anesthesia with conscious sedation, the most used modalities, in terms of anesthetic induction and procedure duration, patient mobility, occlusion location, hemodynamic parameters, outcome and safety; it also focuses on the state-of-the-art on physiologic and pharmacologic neuroprotection. CONTENTS: Most of the evidence on this topic is retrospective and contradictory, with only three small randomized studies to date. Conscious sedation was frequently associated with better outcomes, but the prospective evidence declared that it has no advantage over general anesthesia concerning that issue. Conscious sedation is at least as safe as general anesthesia for the endovascular treatment of acute ischemic stroke, with equivalent mortality and fewer complications like pneumonia, hypotension or extubation difficulties. It has, however, a higher frequency of patient agitation and movement, which is the main cause for conversion to general anesthesia. CONCLUSIONS: General anesthesia and conscious sedation are both safe alternatives for anesthetic management of patients submitted to endovascular thrombectomy. No anesthetic management is universally recommended and hopefully the ongoing randomized clinical trials will shed some light on the best approach; meanwhile, the choice of anesthesia should be based on the patient's individual characteristics. Regarding neuroprotection, hemodynamic stability is currently the most important strategy, as no pharmacological method has been proven effective in humans. Elsevier 2018-07-24 /pmc/articles/PMC9391700/ /pubmed/30195628 http://dx.doi.org/10.1016/j.bjane.2018.06.003 Text en © 2018 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Review Article
Tinoco, Catarina Sousa Laranjo
Santos, Patrícia Marlene Carvalho dos
Anesthetic management of endovascular treatment for acute ischemic stroke: Influences on outcome and complications
title Anesthetic management of endovascular treatment for acute ischemic stroke: Influences on outcome and complications
title_full Anesthetic management of endovascular treatment for acute ischemic stroke: Influences on outcome and complications
title_fullStr Anesthetic management of endovascular treatment for acute ischemic stroke: Influences on outcome and complications
title_full_unstemmed Anesthetic management of endovascular treatment for acute ischemic stroke: Influences on outcome and complications
title_short Anesthetic management of endovascular treatment for acute ischemic stroke: Influences on outcome and complications
title_sort anesthetic management of endovascular treatment for acute ischemic stroke: influences on outcome and complications
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9391700/
https://www.ncbi.nlm.nih.gov/pubmed/30195628
http://dx.doi.org/10.1016/j.bjane.2018.06.003
work_keys_str_mv AT tinococatarinasousalaranjo anestheticmanagementofendovasculartreatmentforacuteischemicstrokeinfluencesonoutcomeandcomplications
AT santospatriciamarlenecarvalhodos anestheticmanagementofendovasculartreatmentforacuteischemicstrokeinfluencesonoutcomeandcomplications