Original Research ARTICLE

Front. Neurol., 11 November 2010 | http://dx.doi.org/10.3389/fneur.2010.00118

Anesthesia and sedation practices among neurointerventionalists during acute ischemic stroke endovascular therapy

  • 1 Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
  • 2 Department of Neurology, Duke University Medical Center, Durham, NC, USA
  • 3 Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA
  • 4 Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
  • 5 Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
  • 6 Department of Neurology, Vanderbilt University Medical Center, Memphis, TN, USA
  • 7 Department of Neurology, University of Louisville Medical Center, Louisville, KY, USA

Background and Purpose: Intra-arterial reperfusion therapies are expanding frontiers in acute ischemic stroke (AIS) management but there is considerable variability in clinical practice. The use of general anesthesia (GA) is one example. We aimed to better understand sedation practices in AIS. Methods: An online survey was distributed to the 68 active members of the Society of Vascular and Interventional Neurology (SVIN). Survey development was based on discussions at the SVIN Endovascular Stroke Round Table Meeting (Chicago, IL, 2008). The final survey contained 12 questions. Questions were developed as single and multiple-item responses; with an option for a free-text response. Results: There was a 72% survey response rate (N = 49/68). Respondents were interventional neurologists in practice 1–5 years (71.4%, N = 35). The mean (±SD) AIS interventions performed per year at the respondents’ institutions was 42.5 ± 25, median 35.0 (IQR 20, 60). The most frequent anesthesia type used was GA (anesthesia team), then conscious sedation (nurse administered), monitored anesthesia care (anesthesia team), and finally local analgesia alone. There was a preference for GA because of eliminating movement (65.3% of respondents; N = 32/49), perceived procedural safety (59.2%, N = 29/49), and improved procedural efficacy (42.9%, N = 21/49). However, cited limitations to GA included risk of time delay (69.4%, N = 34), of propagating cerebral ischemia due to hypoperfusion or other complications (28.6%, N = 14), and lack of adequate anesthesia workforce (20.4%, N = 7). Conclusions: The most frequent type of anesthesia used by Neurointerventionalists for AIS interventions is GA. Prior to making GA standard of care during AIS intervention, more data are needed about effects on clinical outcomes.

Keywords: anesthesia, acute ischemic stroke, endovascular, intra-arterial, neurointerventional

Citation: Mcdonagh DL, Olson DM, Kalia JS, Gupta R, Abou-Chebl A and Zaidat OO (2010) Anesthesia and sedation practices among neurointerventionalists during acute ischemic stroke endovascular therapy. Front. Neur. 1:118. doi:10.3389/fneur.2010.00118

Received: 14 May 2010; Paper pending published: 14 June 2010;
Accepted: 28 July 2010; Published online: 11 November 2010.

Edited by:

Randall Edgell, St. Louis University, USA

Reviewed by:

Eliahu Feen, St. Louis University, USA;
Sushant Kale, St. Louis University, USA;
Vora Nirav, Saint Louis University School of Medicine, USA;
Amer Alshekhlee, Case Western Reserve University, USA

Copyright: © 2010 Mcdonagh, Olson, Kalia, Gupta, Abou-Chebl and Zaidat. This is an open-access publication subject to an exclusive license agreement between the authors and the Frontiers Research Foundation, which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited.

*Correspondence: Osama O. Zaidat, Neurointerventional Program, Departments of Neurology, Radiology and Neurosurgery, Medical College of Wisconsin and Froedtert Hospital West 9200 W. Wisconsin Ave; Milwaukee, WI 53226, USA. e-mail: szaidat@mcw.edu