I'd like to start a discussion and/or debate on the various methods of anaesthesia for endovascular therapy for acute stroke,and also the monitoring techniques etc.
We've seen the results of the more recent trials,but what are we using in wider practice,outside the confines of clinical trials,and how are we managing our patients.
I'd value a wide-ranging discussion,theoretical and practical,and perhaps most usefully,to put us in touch with each other,and to share our views and techniques.
Thank you,
Ian
Perhaps easier to start it by adding our base technique for our cases....
Monitoring is easiest to begin with...
ECG
SaO2
NIBP as minimum,with IABP via side arm of sheath or radial art line
If converting to,or starting as GA:
ETCO2
INVOS
We always use supplemental O2 via nasal prongs(plus ETCO2 via same if possible)
Midazolam for sedation cases
Propofol/Fentanyl/Atracurium or Rocuronium
O2/air
Control ETCO2 and systolic BP
Either HDU or ITU post op
Dear Prof Ian Ewart ,
Do you require planned tracheal intubation? What were those usual situations? Regards- Rabiul.
Hi Rabiul,
Overall,we aim not to intubate our patients.
The current evidence includes a lot of data from older trials,which favoured not intubating patients,and associated GA with a poorer outcome.
There are however several problems with the data,in that sicker patients with higher NIHSS scores tended to get intubated and thus the outcome was automatically poorer.
Also,there were no protocols for GA,and methods varied widely.
The newer trials such as SIESTA,GOLIATH and ANSTROKE,used protocol driven GA,and achieved results at least comparable to not using GA.
So....on average we intubate about 15% of our patients,and that's confined to the following groups:
Patients with basilar occlusions,who will invariably require intubation at some point,and thos patients who become obtunded or combative during a procedure,and require intubation to safegaurd them or their airways or to make the procedure possible.
We have a protocolised method very similar to that of the newer trials,and can also achieve door-to-needle times as good as non GA methods.
That requires close integration of stroke,anaesthetic and neurointerventional teams,but reaps excellent results.
Dear Ian Ewart , Lot of thanks for enlightening ourselves regarding anaesthesia for these delicate procedures. Kind regards- Rabiul.
Hello my dear colleagues
Conscious sedation is the safer and commonly used technique for endovascular therapy for acute stroke .
But some endovascular therapists may prefer doing the procedure under general anesthesia with endotracheal intubation.
The patient is monitored by the same as Dr Ian Ewart said .
My best regards for you all
OFA ( ketamine - propofol or dexmetomedine ) Bis monitiring in the field of minimal invasive technique.
- Badges
- Science topic
- Similar topics
- Biological Science
- Anatomy
- Tissue