High rates of conversion of anesthesia modality in agitated thrombectomy patients

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Background: Patients with large vessel occlusion acute ischemic stroke (AIS) undergoing thrombectomy can be disruptively agitated. We aimed to determine if procedural and neurological outcomes differ for agitated patients. Methods: We reviewed prospectively collected data of AIS patients undergoing thrombectomy in our tertiary center between January 2014 and July 2017. We divided patients in two cohorts based on the presence of disruptive levels of agitation. We compared the baseline characteristics, procedural details and outcomes between the two cohorts. Results: A total of 156 patients were included, 60 (38.5%) were agitated. The agitated cohort had lower mean ASPECTS (8.3 vs 8.8, p 0.04); but other characteristics were well-matched (age, gender, premorbid mRS, occlusion side, NIHSS and tPA status). There was a trend for longer room arrival-to-recanalization times (87.1 vs 72.9 mins, p 0.09) and higher use of general anesthesia (GA) (35% vs 24%, p 0.14) in the agitated cohort (table 1). In the agitated cohort, pre-planned GA patients had longer arrival to recanalization times when compared with monitored anesthesia care (MAC) only patients (100.5 ± 73.0 vs 75.3 ± 49.8 mins). None of the non-agitated MAC patients required conversion to GA, however 11.6% of the agitated patients were converted to GA intra-procedurally, with the longest arrival-to-recanalization time (125.1 ± 68.7) (p 0.04). Other technical details (method of thrombectomy, number of passes, complications and degree of recanalization) and outcome measures (postoperative NIHSS or good neurological outcome at 90 days) were not different between groups. Conclusions: Agitated patients have a high incidence of conversion from MAC to GA resulting in delay in recanalization compared to pre-planned GA. Our study was limited by a small sample size and larger studies are necessary to elucidate the impact of agitation on outcome and whether there is role for pre-planned GA in agitated thrombectomy patients.




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