Anaesthesia for mechanical thrombectomy: a narrative review.
Anaesthesia
; 77 Suppl 1: 59-68, 2022 Jan.
Article
en En
| MEDLINE
| ID: mdl-35001387
ABSTRACT
Stroke is a leading cause of death and disability, and is associated with a huge societal and economic burden. Interventions for the immediate treatment of ischaemic stroke due to large vessel occlusion are dependent on recanalisation of the occluded vessel. Trials have provided evidence supporting the efficacy of mechanical thrombectomy in ischaemic stroke due to large vessel occlusion. This has resulted in changes in management and organisation of stroke care worldwide. Major determinants of effectiveness of thrombectomy include time between stroke onset and reperfusion; location of occlusion and local collateral perfusion; adequacy of reperfusion; patient age; and stroke severity. The role of anaesthetic technique on outcome remains controversial with published research showing conflicting results. As a result, choice of conscious sedation or general anaesthesia for mechanical thrombectomy is often dependent on individual operator choice or institutional preference. More recent randomised controlled trials have suggested that protocol-driven general anaesthesia is no worse than conscious sedation and may even be associated with better outcomes. These and other studies have highlighted the importance of optimal blood pressure management as a major determinant of patient outcome. Anaesthetic management should be tailored to the individual patient and circumstances. Acute ischaemic stroke is a neurological emergency; clinicians should focus on minimising door-to-groin puncture time and the provision of high-quality periprocedural care with a particular emphasis on the maintenance of an adequate blood pressure.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
6_cerebrovascular_disease
Asunto principal:
Sedación Consciente
/
Trombectomía
/
Complicaciones Intraoperatorias
/
Anestesia General
/
Anestesia Local
Tipo de estudio:
Clinical_trials
/
Diagnostic_studies
/
Guideline
Límite:
Humans
Idioma:
En
Revista:
Anaesthesia
Año:
2022
Tipo del documento:
Article
País de afiliación:
Reino Unido