Anaesthesia for mechanical thrombectomy: a narrative review

Summary Stroke is a leading cause of death and disability, and is associated with a huge societal and economic burden. Interventions for the immediate treatment of ischaemic stroke due to large vessel occlusion are dependent on recanalisation of the occluded vessel. Trials have provided evidence sup...

Full description

Saved in:
Bibliographic Details
Published in:Anaesthesia 2022-01, Vol.77 (S1), p.59-68
Main Authors: Dinsmore, J. E., Tan, A.
Format: Article
Language:English
Subjects:
Adequacy
anaesthesia
Anesthesia
Anesthesia, General - methods
Anesthesia, General - standards
Anesthesia, Local - adverse effects
Anesthesia, Local - methods
Anesthesia, Local - standards
Blood pressure
Blood vessels
Brain Ischemia - drug therapy
Brain Ischemia - surgery
Clinical trials
Conscious Sedation - adverse effects
Conscious Sedation - methods
Conscious Sedation - standards
Emergency exits
General anesthesia
Humans
Intraoperative Complications - chemically induced
Intraoperative Complications - diagnosis
Intraoperative Complications - prevention & control
Ischemia
Occlusion
Patients
Perfusion
Randomized Controlled Trials as Topic - methods
Reperfusion
Stroke
Stroke - drug therapy
Stroke - surgery
thrombectomy
Thrombectomy - adverse effects
Thrombectomy - methods
Thrombectomy - standards
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary Stroke is a leading cause of death and disability, and is associated with a huge societal and economic burden. Interventions for the immediate treatment of ischaemic stroke due to large vessel occlusion are dependent on recanalisation of the occluded vessel. Trials have provided evidence supporting the efficacy of mechanical thrombectomy in ischaemic stroke due to large vessel occlusion. This has resulted in changes in management and organisation of stroke care worldwide. Major determinants of effectiveness of thrombectomy include: time between stroke onset and reperfusion; location of occlusion and local collateral perfusion; adequacy of reperfusion; patient age; and stroke severity. The role of anaesthetic technique on outcome remains controversial with published research showing conflicting results. As a result, choice of conscious sedation or general anaesthesia for mechanical thrombectomy is often dependent on individual operator choice or institutional preference. More recent randomised controlled trials have suggested that protocol‐driven general anaesthesia is no worse than conscious sedation and may even be associated with better outcomes. These and other studies have highlighted the importance of optimal blood pressure management as a major determinant of patient outcome. Anaesthetic management should be tailored to the individual patient and circumstances. Acute ischaemic stroke is a neurological emergency; clinicians should focus on minimising door‐to‐groin puncture time and the provision of high‐quality periprocedural care with a particular emphasis on the maintenance of an adequate blood pressure.
ISSN:0003-2409
1365-2044
DOI:10.1111/anae.15586