Subject(s)
Laryngoscopes , Laryngoscopy , Humans , Operating Rooms , Intubation, Intratracheal , Intensive Care UnitsABSTRACT
BACKGROUND: Recent meta-analyses and randomized studies have shown that among patients with acute ischemic stroke undergoing endovascular thrombectomy, general anesthesia with mechanical ventilation is associated with better functional status compared to local anesthesia and sedation, and they recommend its use. But once the procedure is completed, when is the optimal moment for extubation? Currently, there are no guidelines recommending the optimal moment for extubation. Prolonged mechanical ventilation time could potentially be linked to increased complications such as pneumonia or disturbances in cerebral blood flow due to the vasodilatation produced by most anesthetic drugs. However, premature extubation in a patient who has suffered a stroke could led to complications such as agitation, disorientation, abolished reflexes, sudden fluctuations in blood pressure, alterations in cerebral blood flow, respiratory distress, bronchial aspiration, and the need for reintubation. We therefore designed a randomized study hypothesizing that early compared with delayed extubation is associated with a better functional outcome 3 months after endovascular thrombectomy treatment under general anesthesia for acute ischemic stroke. METHODS: This investigator-initiated, single-center, prospective, parallel, evaluated blinded, superiority, randomized controlled trial will include 178 patients with a proximal occlusion of the anterior circulation treated with successful endovascular thrombectomy (TICI 2b-3) under general anesthesia. Patients will be randomly allocated to receive early (< 6 h) or delayed (6-12 h) extubation after the procedure. The primary outcome measure is functional independence (mRS of 0-2) at 90 days, measured with the modified Rankin Score (mRS), ranging from 0 (no symptoms) to 6 (death). DISCUSSION: This will be the first trial to compare the effect of mechanical ventilation duration (early vs delayed extubation) after satisfactory endovascular thrombectomy for acute ischemic stroke under general anesthesia. TRIAL REGISTRATION: The study protocol was approved April 11, 2023, by the by the Santiago-Lugo Research Ethics Committee (CEI-SL), number 2023/127, and was registered into the clinicaltrials.gov clinical trials registry with No. NCT05847309. Informed consent is required. Participant recruitment begins on April 18, 2023. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences.
Subject(s)
Airway Extubation , Anesthesia, General , Endovascular Procedures , Ischemic Stroke , Thrombectomy , Humans , Thrombectomy/methods , Thrombectomy/adverse effects , Prospective Studies , Ischemic Stroke/physiopathology , Ischemic Stroke/surgery , Ischemic Stroke/therapy , Endovascular Procedures/methods , Endovascular Procedures/adverse effects , Time Factors , Treatment Outcome , Randomized Controlled Trials as Topic , Recovery of Function , Functional Status , Equivalence Trials as Topic , Respiration, Artificial , MaleSubject(s)
COVID-19 , Quality of Life , Aftercare , Functional Status , Humans , Patient Discharge , SARS-CoV-2Subject(s)
COVID-19/therapy , Dexmedetomidine/administration & dosage , Oxygen Inhalation Therapy/methods , Oxygen/administration & dosage , Prone Position , Wakefulness , Aged , Aged, 80 and over , Humans , Hypnotics and Sedatives/administration & dosage , Male , Middle Aged , Pandemics , Patient Positioning/methods , SARS-CoV-2ABSTRACT
STUDY OBJECTIVE: To compare duration of labor, mode of delivery, and local anesthetic consumed in women who received labor analgesia with epidural or combined spinal-epidural technique. DESIGN: Retrospective, observational study. SETTING: Delivery room of a university hospital. PATIENTS: 788 nulliparous women in labor at term with cervical dilation between three and 5 cm. INTERVENTIONS: In Group E (epidural alone), parturients received an epidural solution of 8 mL (levobupivacaine 0.125% with fentanyl 5 microg/mL). In Group CSE (combined spinal-epidural), parturients received a spinal injection of levobupivacaine two mg with fentanyl 15 microg (total volume two mL). Then an epidural catheter was placed in all patients and connected to a patient-controlled analgesia pump (basal infusion rate of 8 mL/hr of 0.1% levobupivacaine and fentanyl two microg/mL, patient-controlled bolus dose of three mL, and lockout time of 30 min). MEASUREMENTS: Labor duration, mode of delivery (spontaneous vaginal vs. instrumental delivery vs. cesarean section), and local anesthetic consumed, were recorded. MAIN RESULTS: Labor analgesia was performed with an epidural technique in 322 patients (40.9%), and a combined spinal-epidural technique in 466 patients (59.1%), of whom 39 Group E women (12.1%) and 46 Group CSE women (9.9%) required cesarean section (P=ns). No differences in the mode of delivery were observed between the groups. Time from analgesia to delivery (Group E: 217 +/- 111 min vs. Group CSE: 213 +/- 115 min; P=ns), and epidural local anesthetic consumed (Group E: 35 +/- 20 mL vs. Group CSE: 33 +/- 20 mL; P=ns), were similar in both groups. CONCLUSIONS: No significant differences were observed between epidural and combined spinal-epidural given for labor analgesia in nulliparous women in duration of labor, mode of delivery, or local anesthetic consumed.