title: Hemodynamics during anesthesia for intra-arterial therapy of acute ischemic stroke.
abstract: OBJECTIVE
  Many studies have suggested a relationship between the type of anesthesia provided during intra-arterial therapy for acute ischemic stroke and patient outcomes. Variability in blood pressure and hypotension have previously been identified as possible reasons for worse outcomes in acute stroke. Our aim was to investigate hemodynamic parameters and neurological outcomes of patients receiving either general anesthesia or conscious sedation for intra-arterial therapy of acute stroke.
  
  
  METHODS
  We performed a retrospective review of patients undergoing intra-arterial therapy from December 2008 to March 2015. Demographic data, baseline National Institutes of Health Stroke Scale score, preoperative physiological variables, procedural details, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate, and modified Rankin Scale scores were recorded.
  
  
  RESULTS
  99 patients were included in the study, with 38 receiving general anesthesia and 61 receiving conscious sedation. Patients who received general anesthesia had a lower maximum SBP (p=0.02), minimum SBP (p<0.0001), minimum DBP (p<0.0001), and minimum MAP (p<0.0001). On multivariate analysis, general anesthesia was associated with lower minimum SBP (p=0.04), DBP (p=0.02), and MAP (p=0.007). Conscious sedation was associated with more favorable neurological outcomes (p=0.02). Patients with favorable neurological outcomes had a lower maximum variability in SBP (p=0.01) and MAP (p=0.03), as well as a higher minimum DBP (p=0.03).
  
  
  CONCLUSIONS
  Patients with acute ischemic stroke undergoing intra-arterial therapy with general anesthesia had lower minimum SBP, DBP, and MAP, greater fluctuations in blood pressure, and less favorable outcomes. More studies are needed to examine the implications of variable and reduced blood pressures and neurological outcomes.
authors.affiliation: Mayo Medical School, Rochester, Minnesota, USA.
authors.forename: Manoj
authors.initials: M
authors.lastname: Jagani
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Rabinstein
authors.affiliation: Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Pasternak
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Kallmes
mesh_terms: D000368:Aged; D000768:Anesthesia, General; D001794:Blood Pressure / Q000187:drug effects; D002341:Carotid Artery Thrombosis / Q000628:therapy; D002544:Cerebral Infarction / Q000628:therapy*; D016292:Procedural Sedation; D005260:Female; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000187:drug effects; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Blood Pressure; Stroke; Thrombectomy