Adverse events with monitored anesthesia care sedation in patients with stroke receiving mechanical thrombectomy

Monitored anesthesia care (MAC) sedation for mechanical thrombectomy in stroke patients is considered safe. The association of MAC sedation with respiratory complications is not well studied.

To evaluate adverse events among patients who receive MAC sedation for treatment of acute stroke with thrombectomy.

A retrospective review of adverse events at a single institution between 2020 and 2024 was performed. Univariate and multivariable logistic regression identified clinical covariates associated with the likelihood of adverse outcomes.

Among 348 patients treated for stroke with MAC, 310 had no adverse events. Univariate analysis showed patients aged 60-69 years were 3.23 times more likely to have an adverse event than patients <60 years old and >8 times more likely to develop acute respiratory failure. Multivariable analysis indicated smokers were 2.4 times more likely to have an adverse event (odds ratio [OR], 2.41; 95% CI, 1.01-5.72; p = 0.046). Patients aged 60-69 were >3 times as likely to require prolonged ventilation (OR, 3.75; 95% CI, 1.12-12.6; p = 0.03). Patients with comorbidities were also >3 times as likely to require prolonged ventilation (OR, 3.45; 95% CI, 1.49-7.95; p = 0.004). Age, sex, race, body mass index, stroke location, and stroke history were not associated with adverse events, ventilator use, or acute respiratory failure.

MAC is a safe method for stroke patients undergoing thrombectomy. Smoking, age 60-69 years, and some comorbidities increased odds of respiratory adverse events, underscoring the importance of preoperative risk stratification.