title: Association of intraprocedural blood pressure and end tidal carbon dioxide with outcome after acute stroke intervention.
abstract: BACKGROUND
  General anesthesia (GA) for acute stroke interventions may be associated with inferior functional outcomes. Our goal was to identify physiologic parameters that mediate this association.
  
  
  METHODS
  Consecutive patients treated at our institution between August 2007 and December 2010 were identified from a prospective database. Clinical data were then extracted by retrospective chart review. Variables significantly associated with outcome in univariate analysis were also examined in multivariate analysis, controlling for well-established prespecified predictors of functional outcome.
  
  
  RESULTS
  Of the 106 patients identified, 20 were excluded (17 due to the absence of 90-day mRS and 3 due to insufficient anesthetic records). Blood pressure (BP) decreased significantly after induction of GA, but there was no association between BP and outcome. End tidal carbon dioxide values (ETCO2) at 60 and 90 min, however, were significantly associated with outcomes in both univariate and multivariate analyses. Mean ETCO2 in patients with favorable outcomes (modified Rankin Scale (mRS) 0-3) was higher than in those with unfavorable outcomes (mRS 4-6): 35.2 mmHg versus 32.2 (p = 0.03) at 60 min and 34.9 versus 31.9 (p = 0.04) at 90 min. The adjusted odds ratios for poor outcomes for each 1 mmHg decrease in ETCO2 were the same: 0.76 (95 % CI 0.65-0.92; p = 0.004) at 60 min and 0.76 (95 % CI 0.61-0.93; p = 0.01) at 90 min.
  
  
  CONCLUSIONS
  While BP decreased significantly in patients undergoing GA for acute stroke intervention, it did not correlate with patient outcome. Decreases in ETCO2 at 30 and 60 min, however, were associated with 90-day mRS.
authors.affiliation: Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Takahashi
authors.forename: Ansgar M
authors.initials: AM
authors.lastname: Brambrink
authors.forename: Michael F
authors.initials: MF
authors.lastname: Aziz
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Macri
authors.forename: Joshua
authors.initials: J
authors.lastname: Raines
authors.forename: Anmol
authors.initials: A
authors.lastname: Multani-Kohol
authors.forename: Holly E
authors.initials: HE
authors.lastname: Hinson
authors.forename: Helmi L
authors.initials: HL
authors.lastname: Lutsep
authors.forename: Wayne M
authors.initials: WM
authors.lastname: Clark
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Fields
mesh_terms: D000367:Age Factors; D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects*; D001794:Blood Pressure / Q000502:physiology*; D002245:Carbon Dioxide / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide