Hypotension during endovascular treatment under general anesthesia for acute ischemic stroke.
Autor: | Collette SL; Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Uyttenboogaart M; Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.; Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Samuels N; Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands.; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.; Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands., van der Schaaf IC; Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands., van der Worp HB; Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands., Luijckx GJR; Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Venema AM; Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Sahinovic MM; Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Dierckx RAJO; Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.; Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Lingsma HF; Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands., Kappen TH; Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands., Bokkers RPH; Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. |
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Jazyk: | angličtina |
Zdroj: | PloS one [PLoS One] 2021 Jun 23; Vol. 16 (6), pp. e0249093. Date of Electronic Publication: 2021 Jun 23 (Print Publication: 2021). |
DOI: | 10.1371/journal.pone.0249093 |
Abstrakt: | Objective: The effect of anesthetic management (general anesthesia [GA], conscious sedation, or local anesthesia) on functional outcome and the role of blood pressure management during endovascular treatment (EVT) for acute ischemic stroke is under debate. We aimed to determine whether hypotension during EVT under GA is associated with functional outcome at 90 days. Methods: We retrospectively collected data from patients with a proximal intracranial occlusion of the anterior circulation treated with EVT under GA. The primary outcome was the distribution on the modified Rankin Scale at 90 days. Hypotension was defined using two thresholds: a mean arterial pressure (MAP) of 70 mm Hg and a MAP 30% below baseline MAP. To quantify the extent and duration of hypotension, the area under the threshold (AUT) was calculated using both thresholds. Results: Of the 366 patients included, procedural hypotension was observed in approximately half of them. The occurrence of hypotension was associated with poor functional outcome (MAP <70 mm Hg: adjusted common odds ratio [acOR], 0.57; 95% confidence interval [CI], 0.35-0.94; MAP decrease ≥30%: acOR, 0.76; 95% CI, 0.48-1.21). In addition, an association was found between the number of hypotensive periods and poor functional outcome (MAP <70 mm Hg: acOR, 0.85 per period increase; 95% CI, 0.73-0.99; MAP decrease ≥30%: acOR, 0.90 per period; 95% CI, 0.78-1.04). No association existed between AUT and functional outcome (MAP <70 mm Hg: acOR, 1.000 per 10 mm Hg*min increase; 95% CI, 0.998-1.001; MAP decrease ≥30%: acOR, 1.000 per 10 mm Hg*min; 95% CI, 0.999-1.000). Conclusions: Occurrence of procedural hypotension and an increase in number of procedural hypotensive periods were associated with poor functional outcome, whereas the extent and duration of hypotension were not. Randomized clinical trials are needed to confirm our hypothesis that hypotension during EVT under GA has detrimental effects. Competing Interests: The authors have declared that no competing interests exist. |
Databáze: | MEDLINE |
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