title: Anesthetic variation and potential impact of anesthetics used during endovascular management of acute ischemic stroke.
abstract: BACKGROUND
  Many authors have reported that general anesthesia (GA), as a generic and uncharacterized therapy, is contraindicated for patients undergoing endovascular management of acute ischemic stroke (EMAIS). The recent American Heart Association update cautiously suggests that it might be reasonable to favor conscious sedation over GA during EMAIS. We are concerned that such recommendations will result in patients undergoing endovascular treatment without consideration of the effects of specific anesthetic agents and anesthetic dose, and without appropriate critical consideration of the individual patient's issues. We hypothesized that significant variation in anesthetic practice comprises GA, and that outcome differences among types of GA would arise.
  
  
  METHODS
  With IRB approval, we examined the records of patients who underwent anterior circulation EMAIS at the University of Pennsylvania from 2010 to 2015. Patients were managed by different anesthesiologists with no specific protocol. We analyzed American Society of Anesthesiologists status, NIH Stroke Scale, type of stroke, procedure, different types of anesthetic, blood pressure control, and outcome metrics. Modified Rankin Scale (mRS) scores were determined from medical records.
  
  
  RESULTS
  GA was used in 91% of patients. Several types of GA were employed: intravenous, volatile, and intravenous/volatile combined. mRS scores ≤2 at discharge were observed in 42.8% of patients receiving volatile anesthesia and were better in patients receiving only volatile agents after induction of anesthesia (p<0.05).
  
  
  CONCLUSIONS
  Our data support the notion that anesthetic techniques and associated physiology used in EMAIS are not homogeneous, making any statements about the effects of generic GA in stroke ambiguous. Moreover, our data suggest that the type of GA may affect the outcome after EMAIS.
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Chitra
authors.initials: C
authors.lastname: Sivasankar
authors.affiliation: Department of Neurosurgery, WestChester Medical Center, Valhalla, New York, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Stiefel
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Miano
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Guy
authors.initials: G
authors.lastname: Kositratna
authors.affiliation: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Sukanya
authors.initials: S
authors.lastname: Yandrawatthana
authors.affiliation: Departments of Radiology, Neurosurgery, and Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hurst
authors.affiliation: Departments of Anesthesiology and Critical Care and Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: W Andrew
authors.initials: WA
authors.lastname: Kofke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D000769:Anesthesia, Inhalation; D000777:Anesthetics; D018685:Anesthetics, Inhalation; D062186:Arterial Pressure / Q000187:drug effects; D001794:Blood Pressure; D002545:Brain Ischemia / Q000601:surgery*; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D018685:Anesthetics, Inhalation
keywords: Brain; Intervention; Pharmacology; Stroke; Thrombectomy