Page 23 - CASA Bulletin of Anesthesiologisy 2022 9(6)-1 (3)

Vol. 9, No 6, 2022

Stroke

Due to the success of mechanical thrombectomy with stent retrievers for large vessel
occlusions there has been an explosion in stroke interventions over the past ten years or so. The
pooled data from three randomized controlled trial has demonstrated equipoise between general
anesthetic and MAC for stroke outcomes when hypotension and hypocarbia are avoided and
outcomes are worse when MAC is converted to GA . The perceived benefit of MAC is a more
3
timely intervention and less physiological disturbance but unless the patient presents in a
condition compatible with successful MAC our practice and others is favoring GA for patient
safety and comfort.

Final thoughts

It is anticipated that with knowledge considerations of the procedures and conditions being
treated in the NIR suite and good communication between the Proceduralist and Anesthesiologist
the outcomes for the patient will be good and the experience satisfying for all those involved.

References

1. Mehran R, Dangas GD, Weisbord SD. Contrast-Associated Acute Kidney Injury. N Engl J Med.
2019;380(22):2146-2155. doi:10.1056/NEJMra1805256
2. Beckett KR, Moriarity AK, Langer JM. Safe Use of Contrast Media: What the Radiologist Needs to
Know. Radiographics. 2015;35(6):1738-1750. doi:10.1148/rg.2015150033
3. Simonsen CZ, Schönenberger S, Hendén PL, et al. Patients Requiring Conversion to General Anesthesia during
Endovascular Therapy Have Worse Outcomes: A Post Hoc Analysis of Data from the SAGA Collaboration. AJNR
Am J Neuroradiol. 2020;41(12):2298-2302. doi:10.3174/ajnr.A6823

Further reading

Anesthesia for endovascular therapy for acute ischemic stroke in adults. Edited by Pasternak JJ, published by
UpToDate Feb 2022
Anaesthesia for Interventional Neuroradiology. Sarah J Muldoon and Ian Appleby, Neurosurgical Anaesthesia| Vol
21, Issue 1, p26-32, Jan 01, 2020 https://doi.org/10.1016/j.mpaic.2019.10.018

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