Saint Luke's Hospital, Kansas City, Missouri, USA.
AJNR Am J Neuroradiol. 2010 Sep;31(8):1533-5. doi: 10.3174/ajnr.A2091. Epub 2010 Apr 15.
In centers performing endovascular treatment for patients with AIS, there is variability in placing patients under general anesthesia. Nonanesthetized patients might move during the procedure leading to complications and prolonging the time to revascularization due to lack of cooperation. However, general anesthesia can lead to a delay of the procedure, an inability to assess the patient during the procedure, and fluctuations of blood pressure. Our center does not routinely either use general anesthesia or sedate patients. We report our experience with nonanesthetized patients undergoing emergent mechanical embolectomy.
We performed a retrospective analysis of 66 consecutive patients enrolled in the MERCI Registry at our center from June 2007 to June 2009. A univariate statistical analysis was performed by using the Fisher exact test for categoric variables and the Student t test for continuous variables in comparing use of general anesthesia with nonanesthetized patient demographics, procedural times, procedural complications, good outcome, and mortality.
Nine patients (13.6%) were placed under general anesthesia, and 57 (86.4%) were awake. Higher baseline NIHSS scores and older age were statistically associated with general anesthesia. No significant difference occurred between groups in the time to groin puncture or procedural times. Revascularization rates were 77% for general anesthesia patients and 70% for nonanesthetized patients (P = .331). The nonanesthetized group had better outcomes, but we did not control these outcomes for other factors. Complications were much more frequent in the general anesthesia patients (22%) than in the nonanesthetized patients (3.5%) (P = .0288).
Performing mechanical embolectomy in nonanesthetized patients at our institution does not prolong procedure time, decrease revascularization rates, increase complication rates, or decrease good outcome. Mechanical embolectomy in nonanesthetized patients is effective and should be considered an option in the treatment of the patient with AIS.
在进行急性缺血性脑卒中（AIS）血管内治疗的中心，对患者实施全身麻醉的方式存在差异。未接受麻醉的患者可能会在手术过程中移动，导致并发症，并由于缺乏合作而延长再灌注时间。然而，全身麻醉可能会导致手术延迟、无法在手术过程中评估患者，以及血压波动。我们中心既不常规使用全身麻醉，也不对患者进行镇静。我们报告了在我们中心接受紧急机械取栓的非麻醉患者的经验。
我们对 2007 年 6 月至 2009 年 6 月期间在我们中心参加 MERCI 注册研究的 66 例连续患者进行了回顾性分析。使用 Fisher 精确检验对分类变量进行单变量统计分析，使用学生 t 检验对连续变量进行单变量统计分析，比较全身麻醉与非麻醉患者的人口统计学、手术时间、手术并发症、良好结局和死亡率。
9 例（13.6%）患者接受全身麻醉，57 例（86.4%）患者保持清醒。较高的基线 NIHSS 评分和年龄与全身麻醉有统计学关联。两组患者的腹股沟穿刺时间或手术时间无显著差异。全身麻醉患者的再灌注率为 77%，非麻醉患者为 70%（P=0.331）。非麻醉组的结局较好，但我们没有控制其他因素对这些结局的影响。全身麻醉患者的并发症发生率（22%）明显高于非麻醉患者（3.5%）（P=0.0288）。
在我们机构对非麻醉患者进行机械取栓不会延长手术时间、降低再灌注率、增加并发症发生率或降低良好结局。非麻醉患者的机械取栓是有效且应考虑作为 AIS 患者治疗的一种选择。
