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De Cassai A, Sella N, Pettenuzzo T, Boscolo A, Busetto V, Dost B, Tulgar S, Cester G, Scotti N, di Paola A, Navalesi P, Munari M. Anesthetic Management of Acute Ischemic Stroke Undergoing Mechanical Thrombectomy: An Overview. Diagnostics (Basel) 2024; 14:2113. [PMID: 39410517 PMCID: PMC11475121 DOI: 10.3390/diagnostics14192113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 10/20/2024] Open
Abstract
Ischemic stroke, caused by the interruption of the blood supply to the brain, requires prompt medical intervention to prevent irreversible damage. Anesthetic management is pivotal during surgical treatments like mechanical thrombectomy, where precise strategies ensure patient safety and procedural success. This narrative review highlights key aspects of anesthetic management in ischemic stroke, focusing on preoperative evaluation, anesthetic choices, and intraoperative care. A rapid yet thorough preoperative assessment is crucial, prioritizing essential diagnostic tests and cardiovascular evaluations to determine patient frailty and potential complications. The decision between general anesthesia (GA) and conscious sedation (CS) remains debated, with GA offering better procedural conditions and CS enabling continuous neurological assessment. The selection of anesthetic agents-such as propofol, sevoflurane, midazolam, fentanyl, remifentanil, and dexmedetomidine-depends on local protocols and expertise balancing neuroprotection, hemodynamic stability, and rapid postoperative recovery. Effective blood pressure management, tailored airway strategies, and vigilant postoperative monitoring are essential to optimize outcomes. This review underscores the importance of coordinated care, incorporating multimodal monitoring and maintaining neuroprotection throughout the perioperative period.
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Affiliation(s)
- Alessandro De Cassai
- Sant’Antonio Anesthesia and Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy;
| | - Nicolò Sella
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy; (N.S.); (T.P.); (A.B.); (P.N.)
| | - Tommaso Pettenuzzo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy; (N.S.); (T.P.); (A.B.); (P.N.)
| | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy; (N.S.); (T.P.); (A.B.); (P.N.)
- Department of Medicine—DIMED, University of Padova, 35131 Padova, Italy
- Thoracic Surgery and Lung Transplant Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, 35122 Padova, Italy
| | - Veronica Busetto
- Cardiac Surgery Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy;
| | - Burhan Dost
- Department of Anesthesiology and Reanimation, Ondokuz Mayis University Faculty of Medicine, Samsun 55220, Türkiye;
| | - Serkan Tulgar
- Department of Anesthesiology and Reanimation, Samsun Training and Research Hospital, Samsun University Faculty of Medicine, Samsun 55280, Türkiye;
| | - Giacomo Cester
- Department of Neruoradiology, University Hospital of Padua, 35128 Padua, Italy; (G.C.); (N.S.); (A.d.P.)
| | - Nicola Scotti
- Department of Neruoradiology, University Hospital of Padua, 35128 Padua, Italy; (G.C.); (N.S.); (A.d.P.)
| | - Alessandro di Paola
- Department of Neruoradiology, University Hospital of Padua, 35128 Padua, Italy; (G.C.); (N.S.); (A.d.P.)
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy; (N.S.); (T.P.); (A.B.); (P.N.)
- Department of Medicine—DIMED, University of Padova, 35131 Padova, Italy
| | - Marina Munari
- Sant’Antonio Anesthesia and Intensive Care Unit, University Hospital of Padua, 35128 Padua, Italy;
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De Cassai A, Geraldini F, Cester G, Calandra S, Caravello M, Causin F, Munari M. Risk factors for prolonged ventilation in patients undergoing endovascular treatment of unruptured intracranial aneurysm: a retrospective cohort study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2022; 72:845-847. [PMID: 35337842 PMCID: PMC9659991 DOI: 10.1016/j.bjane.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 12/04/2022]
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Sou BS, Aglio LS, Zhou J. Anesthetic Management of Acute Ischemic Stroke in the Interventional Neuro-Radiology Suite: State of the Art. Curr Opin Anaesthesiol 2021; 34:476-481. [PMID: 34074884 DOI: 10.1097/aco.0000000000001020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review discusses the general anesthetic approach of endovascular stroke therapy and highlights recent advances and considerations for optimal intraoperative management of acute ischemic stroke. RECENT FINDINGS Recent randomized controlled trials have shown no differences in clinical outcomes between monitored anesthesia care with sedation compared with general anesthesia for endovascular stroke therapy. The COVID-19 pandemic has complicated decision-making in the neurointerventional setting. Advances in imaging techniques have extended the window of treatment for endovascular therapy. SUMMARY Optimal time to intervention, hemodynamic stability, novel imaging techniques, and careful consideration of anesthetic plan can impact patient outcomes in reperfusion stroke therapy.
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Affiliation(s)
- Brian S Sou
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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