.jpg "Daniel Najafali, BS photo")
Daniel Najafali, BS
University of Maryland Research Associate Program
Baltimore, MD
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Adelina Buganu, MD
Resident
8Department of Emergency Medicine, Mercer University at Coliseum Medical Center, Macon, Georgia, USA, United States
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Kim Vuong, BS
Student
1The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
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Bhakti Panchal, BS
Medical Student
1The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
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Muhammad Ullah, BS
Student
University of Maryland Research Associate Program, United States
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Karen Yarbrough, DNP, CRNP
Stroke Program Director
3Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
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Austin Widjaja
Student
1The Research Associate Program in Emergency Medicine and Critical Care, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
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Gaurav Jindal, MD
Physician
3Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA 4Department of Neuroradiology, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
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Nathaniel Woods, BSN, CCRN
Registered Nurse
7The Critical Care Resuscitation Unit, University of Maryland Medical Center, Baltimore, Maryland, USA, United States
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Daniel Haase, MD, (he/him/his)
Associate Professor of Emergency Medicine and Surgery
R. Adams Cowley Shock Trauma Center
Baltimore, MD
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Neeraj Badjatia, MD, MS, FCCM
Chief, Neurocritical Care
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center
Baltimore, MD
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Nicholas Morris, MD
Associate Professor
University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center
Baltimore, MD
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Melissa Pergakis, MD
Fellow in Neurology
3Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland, USA, United States
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Quincy Tran, MD, PhD, FCCM
Associate Professor
University of Maryland Medical Center
Baltimore, MD, United States
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Title: Outcomes in Acute Stroke Thrombectomy Patients: General Anesthesia vs. Conscious Sedation
Introduction: Patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) frequently have depressed mental status so they often require general anesthesia (GA) and intubation to protect their airway while undergoing mechanical thrombectomy (MT). Previous studies have raised concerns that GA is associated with worse outcomes when compared to patients undergoing conscious sedation. Our study compared outcomes between patients undergoing GA for MT versus non-intubated patients receiving conscious sedation.
Methods: We performed a retrospective review of our Comprehensive Stroke Center’s registry of all adult patients undergoing MT between 01/2016 and 12/2019. We excluded patients who had occlusion of the posterior circulation or who did not undergo MT. Outcomes were prevalence of in-hospital pneumonia and poor functional independence, defined as modified Rankin Scale (mRS) ≥3. We used multivariable logistic regressions to evaluate the association of patients’ clinical features and outcomes.
Results: We analyzed the records of 396 patients with AIS-LVO of the anterior circulation, mean age (± standard deviation [SD]) was 65 (15) years. Patients’ median [interquartile range, IQR] Alberta Stroke Program Early Computed Tomography scores (ASPECTS) was 9 [8-10] and National Institutes of Health Stroke Scale (NIHSS) score was 18 [13-21]. A total of 196 (49%) patients received GA, 43 (11%) intubated patients had pneumonia, compared to 19 (5%, P< 0.001) for non-intubated patients. Multivariable logistic regression analysis demonstrated that GA (OR 3.09, 95% CI 1.73-5.53, P< 0.001), high NIHSS (OR 1.09, 95% CI 1.04-1.14), 24-hour standard deviation in systolic blood pressure (SBPSD) (OR 1.24, 95% CI 1.06-1.46), and increased age were significantly associated with poor functional outcome, while successful recanalization (Thrombolysis in Cerebral Infarction scale 2b-3, OR 0.24, 95% CI 0.11-0.54) was protective.
Conclusions: The prevalence of pneumonia was significantly higher among intubated patients with AIS-LVO. Among other clinical factors, 24-hour blood pressure variability was also associated with functional outcome. Future studies are necessary to determine the risks and benefits of GA and outcomes among patients with AIS-LVO.