Anesthetics management strategy for endovascular treatment of acute ischemic stroke. A proposal for anesthetic approach
1U.O. Anestesia e Rianimazione, Ospedale “M. Bufalini” AUSL della Romagna Hospital, 286, Viale Ghirotti, Cesena, Italy
2U.O. Neurologia, Ospedale “M. Bufalini” AUSL della Romagna Hospital, 286, Viale Ghirotti, Cesena, Italy
3U.O. Neuroradiologia, Ospedale “M. Bufalini” AUSL della Romagna Hospital, 286, Viale Ghirotti, Cesena, Italy
Online publish date: 22 February 2021
GEAcute ischemic stroke is one of the leading causes of death and long-term disability for adults.
Endovascular therapy is the standard of care for severe acute ischemic stroke, caused by large-vessel occlusion in the anterior circulation; however, the optimal anaesthetic management during the procedure is still a matter of debate. The best anesthetic treatment should mainly be related to patients’ clinical conditions and the site of arterial occlusion. With this article, we share our experience based on the use of ketamine as the choosen hypnotic drug for general anesthesia, in order to avoid a sudden drop in blood pressure. The core of our proposal approach is the general anesthesia management by the medical emergency team with skills on both time-dependent diseases and neurocritical care.
Acute ischemic stroke; Anesthesia; Blood pressure; Endovascular trombectomy; Sedation; Neurocritical careERHWEH
Emanuele Russo,Daniele Bellantonio,Marco Benni,Emiliano Gamberini,Alessandro Circelli,Lorenzo Viola,Alessio Cittadini,Luca Bissoni,Dell’Amore Cristian,Martino Costanza,Giuliano Bolondi,Domenico Pietro Santonastaso,Marco Longoni,Maria Ruggiero,Vanni Agnoletti on the behalf of the Medical Emergency Team of Ospedale Bufalini Cesena. Anesthetics management strategy for endovascular treatment of acute ischemic stroke. A proposal for anesthetic approach. Signa Vitae. 2021.doi:10.22514/sv.2021.031.
 Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018; 137: e67-e492.
 Arboix A, Alioc J. Cardioembolic stroke: clinical features, specific cardiac disorders and prognosis. Current Cardiology Reviews. 2010; 6: 150-161.
 Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. The Lancet. 2016; 387: 1723-1731.
 Saver JL. Time is brain-quantified. Stroke. 2006; 37: 263-266.
 Powers William J, Rabinstein Alejandro A, Ackerson T, Adeoye Opeolu M, Bambakidis Nicholas C, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018; 49: e46-e110.
 Ilyas A, Chen C, Ding D, Foreman PM, Buell TJ, Ironside N, et al. Endovascular mechanical thrombectomy for acute ischemic stroke under general anesthesia versus conscious sedation: a systematic review and meta-analysis. World Neurosurgery. 2018; 112: e355-e367.
 Rasmussen LK, Simonsen CZ, Rasmussen M. Anesthesia practice for endovascular therapy of acute ischemic stroke in Europe. Current Opinion in Anaesthesiology. 2019; 32: 523-530.
 Campbell BCV, van Zwam WH, Goyal M, Menon BK, Dippel DWJ, Demchuk AM, et al. Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. The Lancet Neurology. 2018; 17: 47-53.
 Löwhagen Hendén P, Rentzos A, Karlsson J, Rosengren L, Sundeman H, Reinsfelt B, et al. Hypotension during endovascular treatment of ischemic stroke is a risk factor for poor neurological outcome. Stroke. 2015; 46: 2678-2680.
 van den Berg LA, Koelman DLH, Berkhemer OA, Rozeman AD, Fransen PSS, Beumer D, et al. Type of anesthesia and differences in clinical outcome after intra-arterial treatment for ischemic stroke. Stroke. 2015; 46: 1257-1262.
 Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G. Basilar artery occlusion. The Lancet Neurology. 2011; 10: 1002-1014.
 Hindman BJ, Dexter F. Anesthetic management of emergency endovas-cular thrombectomy for acute oschemic stroke, Part 2. Anesthesia & Analgesia. 2019; 128: 706-717.
 Castioni CA, Rasulo F, Munari M. Letter by Castioni et al. Regarding Article, “General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke”. Stroke. 2020; 51: e331-e332.
 Agnoletti V, Russo E, Circelli A, Benni M, Bolondi G, Martino C, et al. From intensive care to step-down units: managing patients throughput in response to COVID-19. International Journal for Quality in Health Care. 2020. (in press)
 Cappellari M, Pracucci G, Forlivesi S, Saia V, Nappini S, Nencini P, et al. General anesthesia versus conscious sedation and local anesthesia during thrombectomy for acute ischemic stroke. Stroke. 2020; 51: 2036-2044.
 Martino C, Russo E, Santonastaso DP, Gamberini E, Bertoni S, Padovani E, et al. Long-term outcomes in major trauma patients and correlations with the acute phase. World Journal of Emergency Surgery. 2020; 15: 6.
 Chieregato A, Volpi A, Gordini G, Ventura C, Barozzi M, Caspani MLR, et al. How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study. BMJ Open. 2017; 7: e016415.
 Gamberini E, Russo E, Martino C, Portolani L, Agnoletti V. “Low cost” simulation in emergency surgical airway can save lives in a level-1 Italian Major Trauma Center. Journal of Emergency Medicine and Intensive Care. 2017; 3: 117.
 Russo E, Santonastaso DP, Gamberini E, Circelli A, Martino C, Agnoletti V. Ketamine in neurocritical care. Journal of Intensive Care Medicine. 2020. (in press)
 Park S, Yook K, Yoo KY, Choi JI, Bae H, You Y, et al. Comparison of the effect of sevoflurane or propofol anesthesia on the regional cerebral oxygen saturation in patients undergoing carotid endarterectomy: a prospective, randomized controlled study. BMC Anesthesiology. 2019; 19: 157.
 Raming L, Moustafa H, Prakapenia A, Barlinn J, Gerber J, Theilen H, et al. Association of anesthetic exposure time with clinical outcomes after endovascular therapy for acute ischemic stroke. Frontiers in Neurology. 2019; 10: 679.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
IndexCopernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.