title: Dexmedetomidine: a safe alternative to general anesthesia for endovascular stroke treatment.
abstract: OBJECTIVE
  There have been reports that general anesthesia (GA) is associated with worse clinical outcomes during intra-arterial treatment (IAT) for stroke. Since traditional sedatives carry the risk of respiratory depression, this retrospective study was designed to compare sedation with the α2 adrenergic agonist dexmedetomidine (DEX) and with GA for IAT procedures.
  
  
  METHODS
  We reviewed our institutional endovascular database of 216 consecutive patients who received DEX or GA for IAT of anterior circulation strokes between September 2010 and July 2012. The demographic, radiographic and angiographic variables between the GA and DEX groups were compared, as well as hemodynamic changes during the procedure. Binary logistic regression models were generated to determine the independent predictors of a favorable outcome (defined as a modified Rankin Score at 90 days of 0-2).
  
  
  RESULTS
  83 patients had IAT performed under DEX sedation. Their demographic characteristics were similar to those given GA except that they were older and had less severe strokes. The GA group experienced greater variations in blood pressure, more hypotension with induction (54% vs 28%, p<0.001) and greater use of vasopressors (79% vs 58%, p<0.001). In our regression models, independent predictors of a good outcome included age, NIH Stroke Scale (NIHSS) score, Alberta Stroke Program Early CT score (ASPECTS), successful reperfusion, lower baseline systolic blood pressure and higher blood pressures during the procedure. DEX was associated with a good outcome when models included NIHSS as the sole measure of stroke severity but was equivalent to GA when ASPECTS was added to the analysis.
  
  
  CONCLUSIONS
  DEX can be safely administered in patients undergoing endovascular reperfusion therapies. Further study is required to determine if outcomes are different among sedatives used during such procedures.
authors.affiliation: Department of Anesthesiology, Emory University, Atlanta, Georgia, USA.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Whalin
authors.forename: Susan
authors.initials: S
authors.lastname: Lopian
authors.forename: Katleen
authors.initials: K
authors.lastname: Wyatt
authors.forename: Chung-Huan J
authors.initials: CH
authors.lastname: Sun
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.forename: Brenda A
authors.initials: BA
authors.lastname: Glenn
authors.forename: Raphael Y
authors.initials: RY
authors.lastname: Gershon
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D054810:Deep Sedation / Q000379:methods*; D020927:Dexmedetomidine / Q000009:adverse effects / Q000627:therapeutic use*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine
keywords: Stroke; Thrombectomy