Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN 55455,
AJNR Am J Neuroradiol. 2013 Jul;34(7):1375-9. doi: 10.3174/ajnr.A3385. Epub 2013 Jan 31.
Neuroendovascular procedures are performed with the patient under conscious sedation (local anesthesia) in varying numbers of patients in different institutions, though the risk of unplanned conversion to general anesthesia is poorly characterized. Our aim was to ascertain the rate of failure of conscious sedation in patients undergoing neuroendovascular procedures and compare the in-hospital outcomes of patients who were converted from conscious sedation to general anesthesia with those whose procedures were initiated with general anesthesia.
All patients who had an endovascular procedure initiated under general anesthesia or conscious sedation were identified through a prospective data base maintained at 2 comprehensive stroke centers. Patient clinical and procedural characteristics, in-hospital deaths, and favorable outcomes (modified Rankin Scale score, 0-2) at discharge were ascertained.
Nine hundred seven endovascular procedures were identified, of which 387 were performed with the patient under general anesthesia, while 520 procedures were initiated with conscious sedation. Among procedures initiated with intent to be performed under conscious sedation, 9 (1.7%) procedures required emergent conversion to general anesthesia. Favorable clinical outcome and in-hospital mortality in patients requiring emergent conversion from conscious sedation to general anesthesia and in those with procedures initiated with general anesthesia were not statistically different (42% versus 50%, P = .73 and 17% versus 13%, P = 1.00, respectively).
In our study, there was a very low rate of conscious sedation failure and associated adverse outcomes among patients undergoing neuroendovascular procedures. Proper patient selection is important if procedures are to be performed with the patient under conscious sedation. Limitations of the methodology used in our study preclude us from offering specific recommendations regarding when to use a specific anesthetic protocol.
在不同机构中，有数量不等的患者在接受神经血管内介入治疗时采用清醒镇静（局部麻醉），但计划性转为全身麻醉的风险特征描述不足。我们的目的是确定在接受神经血管内介入治疗的患者中清醒镇静失败的发生率，并比较从清醒镇静转为全身麻醉的患者与直接采用全身麻醉患者的院内转归。
通过在 2 家综合卒中中心维护的前瞻性数据库，确定所有接受全身麻醉或清醒镇静诱导的血管内介入治疗的患者。确定患者的临床和手术特征、院内死亡和出院时的良好转归（改良 Rankin 量表评分 0-2）。
共确定了 907 例血管内介入治疗，其中 387 例采用全身麻醉，520 例采用清醒镇静。在拟采用清醒镇静诱导的手术中，有 9 例（1.7%）需要紧急转为全身麻醉。需要从清醒镇静紧急转为全身麻醉的患者与直接采用全身麻醉的患者的临床良好转归和院内死亡率无统计学差异（42%比 50%，P=.73；17%比 13%，P=1.00）。
在我们的研究中，接受神经血管内介入治疗的患者中清醒镇静失败及相关不良结局的发生率非常低。如果要在清醒镇静下进行手术，正确选择患者非常重要。我们研究中采用的方法学存在局限性，无法提供关于何时使用特定麻醉方案的具体建议。
