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Emergency Conversion to General Anesthesia Is a Tolerable Risk in Patients Undergoing Mechanical Thrombectomy.
Flottmann, F; Leischner, H; Broocks, G; Faizy, T D; Aigner, A; Deb-Chatterji, M; Thomalla, G; Krauel, J; Issleib, M; Fiehler, J; Brekenfeld, C.
Afiliação
  • Flottmann F; From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.) f.flottmann@uke.de.
  • Leischner H; From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.).
  • Broocks G; From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.).
  • Faizy TD; From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.).
  • Aigner A; Institute of Medical Biometry and Epidemiology (A.A.).
  • Deb-Chatterji M; Institute of Public Health (A.A.), Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Thomalla G; Departments of Neurology (M.D.-C., G.T.).
  • Krauel J; Departments of Neurology (M.D.-C., G.T.).
  • Issleib M; Anaesthesiology (J.K., M.I.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Fiehler J; Anaesthesiology (J.K., M.I.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Brekenfeld C; From the Department of Diagnostic and Interventional Neuroradiology (F.F., H.L., G.B., T.D.F., J.F., C.B.).
AJNR Am J Neuroradiol ; 41(1): 122-127, 2020 01.
Article em En | MEDLINE | ID: mdl-31806594
ABSTRACT
BACKGROUND AND

PURPOSE:

Mechanical thrombectomy for acute ischemic stroke is performed with the patient under local anesthesia, conscious sedation, or general anesthesia. According to recent trials, up to 16% of patients require emergency conversion to general anesthesia during mechanical thrombectomy. This study investigated the procedural and clinical outcomes after emergency conversion in comparison with local anesthesia, conscious sedation, and general anesthesia. MATERIALS AND

METHODS:

This retrospective study included 254 patients undergoing mechanical thrombectomy for acute large-vessel occlusion. The procedure was started with the patient either under local anesthesia, conscious sedation, or general anesthesia. Emergency conversion was defined as induction of general anesthesia during mechanical thrombectomy. The primary outcomes were successful reperfusion (TICI 2b/3) and functional independence (mRS at 90 days, ≤2).

RESULTS:

Twenty-five patients (9.8%) required emergency conversion to general anesthesia. The time from admission to flow restoration was increased under general anesthesia (median, 137 minutes) and emergency conversion (median, 138 minutes) compared with local anesthesia (median 110 minutes). After adjustment for confounders, emergency conversion to general anesthesia and primary general anesthesia had comparable chances of successful reperfusion (OR = 1.28; 95% CI, 0.31-5.25). Patients with emergency conversion had a tendency toward higher chances of functional independence (OR = 4.48; 95% CI, 0.49-40.86) compared with primary general anesthesia, but not compared with local anesthesia (OR = 0.86; 95% CI, 0.14-5.11) and conscious sedation (OR = 1.07; 95% CI, 0.17-6.53).

CONCLUSIONS:

Patients with emergency conversion did not have lower chances of successful reperfusion or functional independence compared those with primary general anesthesia, and time to flow restoration was also similar. We found no evidence supporting the primary induction of general anesthesia in patients at risk for emergency conversion.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sedação Consciente / Trombectomia / Acidente Vascular Cerebral / Anestesia Geral Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: AJNR Am J Neuroradiol Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Sedação Consciente / Trombectomia / Acidente Vascular Cerebral / Anestesia Geral Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: AJNR Am J Neuroradiol Ano de publicação: 2020 Tipo de documento: Article