Department of General Anesthesia, Anesthesiology and Pain Management Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Outcomes Research, Anesthesiology and Pain Management Institute, Cleveland Clinic, Cleveland, OH, USA.
J Neurointerv Surg. 2023 May;15(5):483-487. doi: 10.1136/neurintsurg-2021-018300. Epub 2022 Jun 13.
There is an ongoing debate about the optimal anesthetic and hemodynamic management of acute stoke patients with large vessel occlusion undergoing endovascular mechanical thrombectomy. Several prospective and retrospective analyses, and randomized controlled trials, attempted to address the challenges of using different anesthetic modalities in acute stroke patients requiring mechanical thrombectomy. We review the advantages and disadvantages of monitored anesthesia care, local anesthesia, conscious sedation, and general anesthesia, along with the relevance of hemodynamic management and perioperative oxygenation status in these complex patients.
目前,对于接受血管内机械取栓治疗的大血管闭塞性急性脑卒中患者,在麻醉和血流动力学管理方面仍存在争议。多项前瞻性和回顾性分析以及随机对照试验尝试解决了在需要机械取栓的急性脑卒中患者中使用不同麻醉方式的挑战。我们综述了监测麻醉管理、局部麻醉、清醒镇静和全身麻醉的优缺点,并讨论了在这些复杂患者中血流动力学管理和围手术期氧合状态的相关性。