Disparities among neurointerventionalists suggest further investigation of conscious sedation versus general anesthesia during thrombectomy for acute stroke.

Autor:	Inam ME; Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.; Department of Neurology, McGovern Medical School, Texas Institute for Restorative Neurotechnologies, University of Texas Health Science Center at Houston, TX, USA.; Department of Biomedical Informatics, School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA., Lekka E; Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Sheriff FG; Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Sanzgiri AA; Research Operations and Conduct, University of Chicago, Chicago, Illinois, USA., Lopez-Rivera V; Department of Neurology, McGovern Medical School, Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, TX, USA., Barreto AD; Department of Neurology, McGovern Medical School, Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, TX, USA., Sheth SA; Department of Neurology, McGovern Medical School, Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, TX, USA., Artime C; Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Engstrom AC; Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Ambrocik A; Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Pedroza C; Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA., Savitz SI; Department of Neurology, McGovern Medical School, Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, TX, USA., Chen PR; Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	Brain circulation [Brain Circ] 2021 Aug 27; Vol. 7 (3), pp. 201-206. Date of Electronic Publication: 2021 Aug 27 (Print Publication: 2021).
DOI:	10.4103/bc.bc_19_21
Abstrakt:	Introduction: Prior retrospective and case-control studies have shown that the use of general anesthesia (GA) during endovascular therapy (EVT) for acute ischemic stroke with large vessel occlusion (AIS-LVO) was independently associated with poor clinical outcomes compared with cases performed under conscious sedation (CS). Conversely, recent small randomized clinical trials (RCT) demonstrated a trend toward better outcome in cases performed under GA. Methods: We submitted an online survey to 193 Society of Vascular Interventional Neurology and 78 American Association of Neurological Surgeons and Congress of Neurological Surgeons - Cerebrovascular Section neuroendovascular practitioners. Questions were aimed at understanding the current state of anesthesia practice during EVT, and to determine if there is clinical equipoise for a large multicenter RCT comparing GA versus CS during EVT. Results: Between March and May of 2017, we received 116 (43%) responses. Anesthesiologists were responsible for managing 96% of the GA cases as compared to only 51% of the CS cases ( P < 0.0001). Notable 56% of providers reported performing less than a quarter of their cases under GA. Only 7% performed all cases under GA compared with 17% who used solely CS ( P = 0.048). More than half of respondents thought a new RCT was necessary, of whom 61% were interested in participating. Among interested responders, 59% were located in centers with 3 or more neurointerventionalists. Conclusion: The significant variation among neuroendovascular providers, added with the lack of consensus among recent trials and meta-analyses, demonstrate clinical equipoise for further studies to explore the effects of anesthesia during EVT in AIS-LVO. Competing Interests: There are no conflicts of interest. (Copyright: © 2021 Brain Circulation.)
Databáze:	MEDLINE
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