Anesthetic management for intra-arterial therapy in stroke

Efforts in intra-arterial treatment of acute ischemic stroke mainly focus on new devices to reperfuse ischemic brain. Equally, if not more important is the anesthesiologists' role in controlling the consciousness level as well as anxiety, movement, airway and respiration and hemodynamic parameters and in a nutshell the safety of patients in a timely manner. We find paucity in studies designed to show the ideal method, level of anesthesia and optimal hemodynamic parameters for these. This review is designed to relate current thought process and debate on the best anesthetic method for this population.

The primary argument in literature regarding anesthetic management in acute ischemic stroke lies in the sedation level. The ongoing debate is whether general anesthesia is better than local anesthesia with or without sedation. Both sides bring their own argument, which seem legitimate but the bulk of the data are based on retrospective experiences rather than a well designed prospective randomized study. The definition of local vs. general anesthesia is still unclear. Retrospective studies mostly fail to identify cases that had to be converted to general anesthesia, which may influence the outcome. Less has been attributed to the importance of hemodynamic control which seems more important regardless of the anesthetic technique. The potential protective and harmful effect of the anesthetics used needs to be considered as well.

Current literature review on anesthetic considerations of intra-arterial treatment of acute ischemic stroke emphasizes the need for well designed prospective studies to demonstrate the role of anesthetics in brain protection if any as well as define a suitable sedation method and guidelines for hemodynamic parameters.