title: Circulatory and Respiratory Parameters during Acute Endovascular Stroke Therapy in Conscious Sedation or General Anesthesia.
abstract: BACKGROUND
  Whether patients suffering from acute ischemic stroke and undergoing endovascular recanalization should be treated under general anesthesia (GA) or conscious sedation (CS) is a matter of debate. According to retrospective studies, GA appears to be associated with a worse outcome than CS. The underlying mechanisms are unknown, but hypotension and hypocapnia during GA have been suggested. There are no prospective data on this question.
  
  
  METHODS
  We prospectively analyzed consecutive patients who were treated with endovascular recanalization from 11, 2013 to 03, 2014 regarding blood pressure, end-tidal carbon dioxide (etCO2), cerebral oximetry (by near-infrared spectroscopy), ventilation parameters, response to commands, basic parameters (age, gender, percentage of posterior circulation stroke, National Institutes of Health Stroke Scale score [NIHSSS] on admission, NIHSSS at discharge, rate of successful recanalization [thrombolysis in cerebral infarction scale >2a], duration of intervention, symptom-to-recanalization time, and door-to-needle time), and medication used.
  
  
  RESULTS
  Forty-four patients (29 under GA and 15 in CS) were included. Significant differences between the groups (GA versus CS) were found in the median dose of norepinephrine (.4 mg/hour versus .1 mg/hour, P = .003), mean systolic blood pressure (139.67 mm Hg versus 155.00 mm Hg, P = .003), mean duration of relative hypotension (systolic blood pressure <140 mm Hg; 42.75 versus 15 minutes, P = .004), and mean etCO2 values (37.29 mm Hg versus 27.33 mm Hg, P = .004).
  
  
  CONCLUSIONS
  In this small prospective study, patients under CS required less vasopressor medication and had a higher mean blood pressure than those under GA, but they also showed signs of hyperventilation. The impact of these physiological differences on outcome needs to be studied in randomized trials.
authors.affiliation: Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany. Electronic address: sibu.mundiyanapurath@med.uni-heidelberg.de.
authors.forename: Sibu
authors.initials: S
authors.lastname: Mundiyanapurath
authors.affiliation: Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Schönenberger
authors.affiliation: Institute for Neuroscience, St. Luke's Medical Center, Boulevard Quezon City, Philippines.
authors.forename: Maritoni L
authors.initials: ML
authors.lastname: Rosales
authors.affiliation: Department of Neurology, Hospital S. Bernado, Centro Hospitalar Setúbal, Setúbal, Portugal.
authors.forename: Ana M
authors.initials: AM
authors.lastname: Carrilho Romeiro
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Möhlenbruch
authors.affiliation: Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Bendszus
authors.affiliation: Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hacke
authors.affiliation: Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Bösel
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D001794:Blood Pressure / Q000502:physiology*; D002545:Brain Ischemia / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy; D016292:Procedural Sedation; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010092:Oximetry; D011446:Prospective Studies; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Stroke; anesthesia; blood pressure; end-tidal carbon dioxide; endovascular recanalization; peri-interventional management