Departments of Anesthesiology and Pain Medicine.
Neurology.
J Neurosurg Anesthesiol. 2018 Jul;30(3):223-230. doi: 10.1097/ANA.0000000000000449.
The choice of anesthetic technique, general anesthesia (GA) versus Monitored Anesthesia Care, may impact the outcome of patients undergoing endovascular treatment of acute ischemic stroke (AIS). The aim of this study was to identify the factors associated with good discharge outcome in patients receiving GA for AIS.
Electronic medical records of patients above 18 years old who underwent endovascular treatment of AIS under GA at a Comprehensive Stroke Center from 2010 to 2014 were reviewed. Good outcome was defined as discharge modified Rankin Score 0 to 2 and poor outcome as modified Rankin Score 3 to 6; logistic regression analysis was performed to examine the association between the clinical characteristics and the outcome.
In total, 88 patients (56 males), aged 63±15 years with median National Institute of Health Stroke Scale (NIHSS) score 16 (range, 4 to 38) were included. Nineteen (22%) patients had good outcome and 78 (88%) had systolic blood pressure below the guideline recommended 140 mm Hg under GA. After adjusting for age and NIHSS score, the independent predictors of good discharge outcomes were higher maximum end-tidal carbon dioxide (odds ratio [OR], 1.14; confidence interval [CI], 1.02-1.28; P=0.02) and extubation after endovascular treatment (OR, 26.31; CI, 4.80-144.12; P<0.0001). A secondary analysis was performed after excluding 25 patients emergently intubated in the Emergency Department for airway protection. In the logistic regression analysis controlling for age and NIHSS score, postprocedure extubation was still associated with higher odds of good outcomes (OR, 13.35; CI, 2.58-68.90; P=0.002).
These findings indicate the importance of ventilation management and extubation after endovascular intervention under GA in patients with AIS.
麻醉技术的选择，全身麻醉（GA）与监测麻醉护理，可能会影响接受血管内治疗急性缺血性脑卒中（AIS）患者的预后。本研究的目的是确定在接受 GA 治疗 AIS 的患者中，与良好出院结局相关的因素。
回顾 2010 年至 2014 年期间在综合卒中中心接受 GA 下血管内治疗 AIS 的年龄大于 18 岁患者的电子病历。良好结局定义为出院改良 Rankin 评分 0 至 2 分，不良结局为改良 Rankin 评分 3 至 6 分；采用逻辑回归分析检查临床特征与结局之间的关联。
共纳入 88 例（56 例男性）年龄 63±15 岁，中位 NIHSS 评分 16 分（范围 4 至 38）。19 例（22%）患者有良好结局，78 例（88%）患者在 GA 下血压低于指南推荐的 140mmHg。在校正年龄和 NIHSS 评分后，良好出院结局的独立预测因素为更高的最大呼气末二氧化碳（优势比 [OR]，1.14；置信区间 [CI]，1.02-1.28；P=0.02）和血管内治疗后拔管（OR，26.31；CI，4.80-144.12；P<0.0001）。排除 25 例因气道保护而在急诊科紧急插管的患者后进行了二次分析。在校正年龄和 NIHSS 评分的逻辑回归分析中，术后拔管仍与良好结局的几率更高相关（OR，13.35；CI，2.58-68.90；P=0.002）。
这些发现表明，在接受 GA 治疗 AIS 的患者中，血管内干预后通气管理和拔管非常重要。
