title: Safety and Hemodynamic Profile of Propofol and Dexmedetomidine Anesthesia during Intra-arterial Acute Stroke Therapy.
abstract: BACKGROUND
  There is limited data on the safety, hemodynamic profile, and outcome of patients undergoing intra-arterial therapy (IAT) for acute ischemic stroke (AIS) under sedation with dexmedetomidine (DEX) versus propofol (PROP).
  
  
  METHODS
  Retrospective study of patients with anterior circulation AIS, who underwent IAT without intubation, and received either DEX or PROP between January 2008 and December 2012, was performed. Demographics, stroke treatments, time metrics, anesthesia, intraprocedural hemodynamics, vasopressor use, infarct volumes, recanalization status, and intracerebral hemorrhage were collected.
  
  
  RESULTS
  Seventy-two patients met inclusion criteria, of which 35 received DEX and 37 PROP. There was no difference in baseline demographics, stroke treatments, successful recanalization, hemorrhages, infarct volume growth, good clinical outcome (mRS ≤ 2 [19% versus 22%, P = .742]), or in-hospital mortality (18% versus 8%, P = .225) between DEX and PROP. The DEX group had lower intraprocedural minimum systolic blood pressure (103 ± 27 versus 114 ± 18 mm Hg, P = .032) and minimum mean arterial pressure (MAP; 67 ± 17 versus 77 ± 10 mm Hg, P = .006). More patients in the DEX group experienced episodes of hypotension (MAP < 60 mm Hg; 24% versus 3%; P = .010) and had higher vasopressor requirement (phenylephrine: 1825 ± 2390 versus 491 ± 884 mcg, P = .007) compared to PROP.
  
  
  CONCLUSIONS
  There was no difference in good clinical outcome or in-hospital mortality in patients undergoing IAT for AIS using DEX versus PROP sedation. However, hemodynamic instability and vasopressor requirement were significantly higher in the DEX group. DEX should be cautiously utilized in IAT.
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio. Electronic address: johns@ccf.org.
authors.forename: Seby
authors.initials: S
authors.lastname: John
authors.affiliation: Department of General Anesthesia, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jaspreet
authors.initials: J
authors.lastname: Somal
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Umera
authors.initials: U
authors.lastname: Thebo
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Hussain
authors.affiliation: Department of General Anesthesia, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag
authors.affiliation: Department of General Anesthesia, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Dupler
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joao
authors.initials: J
authors.lastname: Gomes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects; D002545:Brain Ischemia / Q000150:complications; D020927:Dexmedetomidine / Q000627:therapeutic use*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D015742:Propofol / Q000627:therapeutic use*; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D015742:Propofol
keywords: Intra-arterial therapy; anesthesia; dexmedetomidine; hemodynamics; outcomes; propofol