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Published on: January 15, 2017
Monitored anesthesia care during mechanical thrombectomy for stroke: need for data-driven and individualized
Raul G Nogueira1, Mahmoud H Mohammaden2, Timothy P Moran3
1Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, Georgia, USA raul.g.nogueira@emory.edu.
The rate of conversion from monitored anesthesia care (MAC) to general anesthesia (GA) during mechanical thrombectomy (MT) for stroke is low (1.6%). Posterior circulation strokes were associated with higher conversion rates, but stroke severity and dominance were not predictors.
Area of Science:
- Neurology
- Anesthesiology
- Interventional Neuroradiology
Background:
- Anesthesia management for mechanical thrombectomy (MT) during the COVID-19 pandemic is debated.
- Guidelines suggest general anesthesia (GA) for high-risk stroke patients.
- Monitored anesthesia care (MAC) is often the default, prompting investigation into conversion rates.
Purpose of the Study:
- To determine the rate of conversion from MAC to GA during MT.
- To identify predictors of intraprocedural GA conversion.
- To analyze conversion rates in specific stroke subgroups.
Main Methods:
- Retrospective review of a prospectively maintained MT database (January 2013 - July 2020).
- Analysis of 1919 MT patients, with a focus on 1677 eligible for conversion analysis.
- Statistical analysis to identify predictors of intraprocedural GA conversion.
Main Results:
- The overall conversion rate from MAC to GA was low at 1.6% (26/1677 patients).
- Posterior circulation strokes had a higher conversion rate (6.5%) compared to anterior circulation strokes (1.4%).
- Posterior circulation stroke was the only significant predictor of GA conversion (OR 4.99).
Conclusions:
- The overall rate of MAC to GA conversion during MT is low.
- Posterior circulation stroke is associated with increased conversion risk, but stroke severity and hemispheric dominance are not predictors.
- Clinical practice should be cautious about changing anesthesia protocols during critical periods based on limited evidence.
