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

Manejo anestésico do tratamento endovascular para acidente vascular cerebral isquêmico agudo: influências no resultado e complicações.

Publisher: Elsevier Editora Ltda Country of Publication: Brazil NLM ID: 101624623 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2352-2291 (Electronic) Linking ISSN: 01040014 NLM ISO Abbreviation: Braz J Anesthesiol Subsets: MEDLINE

Original Publication: Rio de Janeiro : Elsevier Editora Ltda, 2013-

Anesthesia, General* ; Conscious Sedation* ; Endovascular Procedures* ; Thrombectomy*; Brain Ischemia/*surgery ; Stroke/*surgery; Brain Ischemia/complications ; Humans ; Postoperative Complications/epidemiology ; Stroke/etiology ; Treatment Outcome

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.
(Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.)

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Keywords: Acidente vascular cerebral; Anestesia; Anestesia geral; Anesthesia; Conscious sedation; Endovascular procedures; General anesthesia; Neuroprotection; Neuroproteção; Procedimentos endovasculares; Sedação consciente; Stroke; Thrombectomy; Trombectomia

Date Created: 20180910 Date Completed: 20190528 Latest Revision: 20220822

20240829

PMC9391700

10.1016/j.bjan.2018.06.004

30195628