General Is Better Than Local Anesthesia During Endovascular Procedures
University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University of Berne, Freiburgstrasse 4, CH-3010 Bern, Switzerland. Stroke
(Impact Factor: 5.72).
10/2010; 41(11):2716-7. DOI: 10.1161/STROKEAHA.110.594622
Available from: Eric J Heyer
Anesthesiology 12/2011; 116(2):244-5. DOI:10.1097/ALN.0b013e318242b1e3 · 5.88 Impact Factor
Available from: Bijoy K Menon
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ABSTRACT: Studies of endovascular treatment for acute ischemic stroke have identified general anesthesia as a predictor for poor outcome in comparison with local anesthesia/sedation. This retrospective study attempts to identify modifiable factors associated with poor outcome, while adjusting for baseline stroke severity, in patients receiving general anesthesia.
We reviewed charts of 129 patients treated between January 2003 and September 2009. The primary outcome was the modified Rankin Score of 0-2 for 3 months poststroke. Predictors of neurologic outcome included baseline National Institutes of Health Stroke Scale score, blood glucose concentration, and age. Additional risk factors evaluated were prolonged stroke onset-treatment interval and systolic blood pressure less than 140 mmHg. Choice of local anesthesia or general anesthesia was recorded.
The study group was 96 out of 129 patients for whom modified Rankin Scale scores were available; 48 patients received general anesthesia and 48 local anesthesia. The proportion of patients with "good" outcomes were 15% and 60% in the general anesthesia group and local anesthesia group, respectively (P < 0.001). Lowest systolic blood pressure and general anesthesia were correlated (r = -0.7, P < 0.001). Independent predictors for good neurologic outcome were local anesthesia, systolic blood pressure greater than 140 mmHg, and low baseline stroke scores.
Adjusted for stroke severity, patients who received general anesthesia for treatment are less likely to have a good outcome than those managed with local anesthesia. This may be due to preintervention risk not included in the stroke severity measures. Hypotension, more frequent in the general anesthesia patients, may also contribute.
Anesthesiology 02/2012; 116(2):396-405. DOI:10.1097/ALN.0b013e318242a5d2 · 5.88 Impact Factor
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ABSTRACT: The article reviews the treatment options for cerebrovascular atherosclerosis and highlights the challenges of anesthesia in this complex group of patients.
Percutaneous transluminal angioplasty and stenting is a treatment option for cerebrovascular atherosclerosis in patients at high risk of stroke despite maximal medical therapy and control of risk factors. The majority of carotid lesions are treated using regional anesthesia, but general anesthesia is currently the technique of choice for intracranial lesions because of the length of the procedures and the need for immobility. There is no evidence to guide optimal anesthetic management in this group of patients in whom significant comorbidities are common. The risks of myocardial ischemia, cardiovascular instability and cerebral ischemia and hyperperfusion are high, and anesthesia management should be directed towards their prevention, recognition and treatment.
The anesthetist plays a key role in the endovascular management of patients with cerebrovascular atherosclerosis. Optimization of comorbidities, meticulous control of systemic physiologic variables and aggressive management of complications contribute to enhanced patient outcome.
Current opinion in anaesthesiology 05/2012; 25(4):486-92. DOI:10.1097/ACO.0b013e328354c958 · 1.98 Impact Factor
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