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Liang F, Zhang K, Wu Y, Wang X, Hou X, Yu Y, Wang Y, Wang M, Pan Y, Huo X, Han R, Miao Z. Anaesthesia modality on endovascular therapy outcomes in patients with large infarcts: a post hoc analysis of the ANGEL-ASPECT trial. Stroke Vasc Neurol 2024:svn-2024-003320. [PMID: 39160092 DOI: 10.1136/svn-2024-003320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/30/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES Endovascular therapy (EVT) now penetrates the once obscure realm of large infarct core volume acute ischaemic stroke (LICV-AIS). This research aimed to investigate the potential correlation between different anaesthetic approaches and post-EVT outcomes in LICV-AIS patients. METHODS Between October 2020 and May 2022, the China ANGEL-Alberta Stroke Programme Early CT Score (ASPECT) trial studied patients with LICV-AIS, randomly assigning them to the best medical management (BMM) or BMM with EVT. This post hoc subgroup analysis categorised subjects receiving BMM with EVT into general anaesthesia (GA) and non-GA groups based on anaesthesia type. We applied multivariable logistic regression to evaluate the relationship between anaesthesia during EVT and patient functional outcomes, as measured by the modified Rankin scale (mRS), in addition to the occurrence of complications. Further adjustment for selection bias was achieved through propensity score matching (PSM). RESULTS In total, 230 patients with LICV-AIS were enrolled (GA 84 vs Non-GA 146). No significant difference was observed between the two groups in terms of the proportion of patients who achieved an mRS score of 0-2 at 90 days (27.4% for the GA group vs 31.5% for the non-GA group, p=0.51). However, the GA group had significantly longer median surgical times (142 min vs 122 min, p=0.03). Furthermore, GA was associated with an increased risk of postoperative pneumonia (adjusted OR 2.03, 95% CI 1.04 to 3.98). The results of PSM analysis agreed with the results of the multivariate regression analysis. No significant difference in intracranial haemorrhage incidence or mortality rate was observed between the groups. CONCLUSION This post hoc analysis of subgroups of the ANGEL-ASPECT trial suggested that there may be no significant association between the choice of anaesthesia and neurological outcomes in LICV-AIS patients. However, compared with non-GA, GA prolongs the duration of EVT and is associated with a greater postoperative pneumonia risk. TRIAL REGISTRATION NUMBER NCT04551664.
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Affiliation(s)
- Fa Liang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kangda Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxuan Wu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinyan Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xuan Hou
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yun Yu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunzhen Wang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mengxing Wang
- Department of Statistics, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Statistics, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaochuan Huo
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ruquan Han
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Chapalain X, Morvan T, Gentric JC, Subileau A, Jacob C, Cadic A, Caillard A, Huet O. Continuous non-invasive vs. invasive arterial blood pressure monitoring during neuroradiological procedure: a comparative, prospective, monocentric, observational study. Perioper Med (Lond) 2024; 13:77. [PMID: 39034414 PMCID: PMC11265173 DOI: 10.1186/s13741-024-00442-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND In the perioperative setting, the most accurate way to continuously measure arterial blood pressure (ABP) is using an arterial catheter. Surrogate methods such as finger cuff have been developed to allow non-invasive measurements and are increasingly used, but need further evaluation. The aim of this study is to evaluate the accuracy and clinical concordance between two devices for the measurement of ABP during neuroradiological procedure. METHODS This is a prospective, monocentric, observational study. All consecutive patients undergoing a neuroradiological procedure were eligible. Patients who needed arterial catheter for blood pressure measurement were included. During neuroradiological procedure, ABP (systolic, mean and diatolic blood pressure) was measured with two different technologies: radial artery catheter and Nexfin. Bland-Altman and error grid analyses were performed to evaluate the accuracy and clinical concordance between devices. RESULTS From March 2022 to November 2022, we included 50 patients, mostly ASA 3 (60%) and required a cerebral embolization (94%) under general anaesthesia (96%). Error grid analysis showed that 99% of non-invasive ABP measures obtained with the Nexfin were located in the risk zone A or B. However, 65.7% of hypertension events and 41% of hypotensive events were respectively not detected by Nexfin. Compared to the artery catheter, a significant relationship was found for SAP (r2 = 0.78) and MAP (r2 = 0.80) with the Nexfin (p < 0.001). Bias and limits of agreement (LOA) were respectively 9.6 mmHg (- 15.6 to 34.8 mmHg) and - 0.8 mmHg (- 17.2 to 15.6 mmHg), for SAP and MAP. CONCLUSIONS Nexfin is not strictly interchangeable with artery catheter for ABP measuring. Further studies are needed to define its clinical use during neuroradiological procedure. TRIAL REGISTRATION Clinicaltrials.gov, registration number: NCT05283824.
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Affiliation(s)
- Xavier Chapalain
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
- Laboratoire ORPHY, Université de Bretagne Occidentale, Brest, France
| | - Thomas Morvan
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Jean-Christophe Gentric
- Department of Neuroradiology, University and Regional Hospital Centre Brest, Brest, France
- Laboratoire GETBO, UMR 1304, Université de Bretagne Occidentale, Brest, France
| | - Aurélie Subileau
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Christophe Jacob
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Anna Cadic
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Anaïs Caillard
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France
| | - Olivier Huet
- Department of Anesthesiology and Surgical Intensive Care, University and Regional Hospital Centre Brest, Boulevard Tanguy Prigent, Brest, Cedex, 29609, France.
- Laboratoire ORPHY, Université de Bretagne Occidentale, Brest, France.
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L'Allinec V, Bouizegarene M, Palka O, Godard S, Mazighi M, Lasocki S, Rineau E, Léger M. Arterial hypotension "magnitude" and neurological outcome during mechanical thrombectomy under general anesthesia. J Stroke Cerebrovasc Dis 2024; 33:107838. [PMID: 38936647 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 06/29/2024] Open
Abstract
INTRODUCTION Mechanical thrombectomy (MT) is the standard of care for the treatment of acute ischemic stroke (AIS) with large vessel occlusion (LVO), but unfavorable outcomes remain common. Procedural arterial hypotension is associated with poor patient outcome. This study aimed to assess the impact of arterial hypotension "magnitude" (a combination of the depth, defined as the percentage relative to baseline arterial blood pressure, and the duration of hypotensive episodes)" during MT on neurological outcome. METHODS This is a monocentric retrospective study. Charts were reviewed between January 2018 and June 2021. "Patients were eligible if they were 18 years or older, anterior LVO was diagnosed on cerebral imaging" and MT performed under general anesthesia. Mean arterial pressure (MAP) was recorded every 5 min throughout the procedure, and the arterial hypotension "magnitude" was estimated by the area under the curve (AUC) for different thresholds of MAP drops. MAIN OUTCOME MEASURE The modified Rankin Scale (mRS) at 90 days. MAIN RESULTS Among the 117 patients analyzed, 46% had poor neurological outcome. Our study showed correlations between poor outcome and a greater procedural AUC of arterial hypotension for the different thresholds: 5% (k 0.18; 95% CI 0.06-0.30; P = 0.007), 10% (k 0.18; 95% CI 0.05-0.30; P = 0.008), 15% (k 0.18; 95% CI 0.04-0.30; P = 0.011), 20% (k 0.18; 95% CI 0.05-0.30; P = 0.010) and 30% (k 0.19; 95% CI 0.05-0.31; P = 0.010). This association persisted after controlling for age, baseline NIHSS score, and ASPECT score. CONCLUSION The magnitude of hypotension during MT under general anesthesia for AIS is an independent factor of poor outcome at 90 days. These associations have been observed in patients with mild and severe hypotensive episodes.
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Affiliation(s)
- Vincent L'Allinec
- Department of Radiology, University Hospital of Angers, Angers 49100, France
| | - Madjid Bouizegarene
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers 49100, France
| | - Océane Palka
- Department of Radiology, University Hospital of Angers, Angers 49100, France
| | - Sophie Godard
- Department of Neurology and Stroke Unit, Angers University Hospital, Angers, France
| | - Mikael Mazighi
- Departments of Interventional Neuroradiology, FHU Neurovasc, INSERM 1148, Rothschild Foundation Hospital, and Neurology Lariboisière Hospital, Paris Cité University, Paris, France
| | - Sigismond Lasocki
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers 49100, France
| | - Emmanuel Rineau
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers 49100, France
| | - Maxime Léger
- Department of Anesthesiology and Intensive Care, University Hospital of Angers, Angers 49100, France; INSERM UMR 1246-SPHERE, Nantes University, Tours University, Nantes, France.
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Lefrant JY, Pirracchio R, Benhamou D, Lorne E, Roquilly A. Good Luck ACCPM. Anaesth Crit Care Pain Med 2024; 43:101329. [PMID: 37981026 DOI: 10.1016/j.accpm.2023.101329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Jean Yves Lefrant
- UR-UM103 IMAGINE, University of Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, Montpellier, France.
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Avenue, San Francisco, USA
| | - Dan Benhamou
- Paris Sud University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Emmanuel Lorne
- Clinique du Millénaire, Department of Anesthesiology and Intensive Care (Akomé), Montpellier, France
| | - Antoine Roquilly
- University of Nantes - Anaesthesiology and Intensive Care Unit, Nantes, France
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