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Anesthetic management for intra-arterial therapy in stroke.
MedLine Citation:
PMID:  22895121     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Efforts in intra-arterial treatment of acute ischemic stroke mainly focus on new devices to reperfuse ischemic brain. Equally, if not more important is the anesthesiologists' role in controlling the consciousness level as well as anxiety, movement, airway and respiration and hemodynamic parameters and in a nutshell the safety of patients in a timely manner. We find paucity in studies designed to show the ideal method, level of anesthesia and optimal hemodynamic parameters for these. This review is designed to relate current thought process and debate on the best anesthetic method for this population. RECENT FINDINGS: The primary argument in literature regarding anesthetic management in acute ischemic stroke lies in the sedation level. The ongoing debate is whether general anesthesia is better than local anesthesia with or without sedation. Both sides bring their own argument, which seem legitimate but the bulk of the data are based on retrospective experiences rather than a well designed prospective randomized study. The definition of local vs. general anesthesia is still unclear. Retrospective studies mostly fail to identify cases that had to be converted to general anesthesia, which may influence the outcome. Less has been attributed to the importance of hemodynamic control which seems more important regardless of the anesthetic technique. The potential protective and harmful effect of the anesthetics used needs to be considered as well. SUMMARY: Current literature review on anesthetic considerations of intra-arterial treatment of acute ischemic stroke emphasizes the need for well designed prospective studies to demonstrate the role of anesthetics in brain protection if any as well as define a suitable sedation method and guidelines for hemodynamic parameters.
Authors:
Rafi Avitsian; Jaspreet Somal
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-14
Journal Detail:
Title:  Current opinion in anaesthesiology     Volume:  -     ISSN:  1473-6500     ISO Abbreviation:  Curr Opin Anaesthesiol     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8813436     Medline TA:  Curr Opin Anaesthesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
aAnesthesiology and Neurological Institutes bAnesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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