Padmanaban Varun, Grzyb Chloe, Velasco Cesar, Richardson Alicia, Cekovich Erin, Reichwein Raymond, Church Ephraim W, Wilkinson David A, Simon Scott D, Cockroft Kevin M
Department of Neurosurgery, Pennsylvania State University College of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Penn State Comprehensive Stroke Center, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Interv Neuroradiol. 2023 Oct 12:15910199231207409. doi: 10.1177/15910199231207409.
The appropriate choice of perioperative sedation during endovascular thrombectomy for ischemic stroke is unknown. Few studies have evaluated the role of nursing-administered conscious sedation supervised by a trained interventionalist.
To compare the safety and efficacy of endovascular thrombectomy for ischemic stroke performed with nursing-administered conscious sedation supervised by a trained interventionalist with monitored anesthesia care supervised by an anesthesiologist.
A retrospective review of a prospectively collected stroke registry was performed. The primary outcome was functional independence at 90 days, defined as a modified Rankin score of 0-2. Propensity score matching was performed to control for known confounders including patient comorbidities, access type, and direct-to-suite transfers.
A total of 355 patients underwent endovascular thrombectomy for large vessel occlusion between 2018 and 2022. Thirty five patients were excluded as they arrived at the endovascular suite intubated. Three hundred and twenty patients were included in our study, 155 who underwent endovascular thrombectomy with nursing-administered conscious sedation and 165 who underwent endovascular thrombectomy with monitored anesthesia care. After propensity score matching, there were 111 patients in each group. There was no difference in modified Rankin score 0-2 at 90 days (26.1% vs 35.1%, 0.190). Patients undergoing monitored anesthesia care received significantly more vasoactive medications (23.4% vs 49.5%, 0.001) and had a lower intraoperative minimum systolic blood pressure (134 vs 123mmHg, 0.046). There was no difference in procedural efficacy, safety, intubation rates, and postoperative complications.
Perioperative sedation with nursing-administered conscious sedation may be safe and effective in patients undergoing endovascular thrombectomy for ischemic stroke.
缺血性中风血管内血栓切除术围手术期镇静的合适选择尚不清楚。很少有研究评估由训练有素的介入专家监督的护士实施的清醒镇静的作用。
比较由训练有素的介入专家监督的护士实施的清醒镇静与麻醉医生监督的麻醉监护下进行缺血性中风血管内血栓切除术的安全性和有效性。
对前瞻性收集的中风登记册进行回顾性分析。主要结局是90天时的功能独立性，定义为改良Rankin评分0 - 2分。进行倾向评分匹配以控制已知的混杂因素，包括患者合并症、入路类型和直接进入手术室。
2018年至2022年期间，共有355例患者因大血管闭塞接受了血管内血栓切除术。35例患者因到达血管内手术室时已插管而被排除。320例患者纳入我们的研究，155例接受护士实施的清醒镇静下的血管内血栓切除术，165例接受麻醉监护下的血管内血栓切除术。倾向评分匹配后，每组有111例患者。90天时改良Rankin评分0 - 2分无差异（26.1%对35.1%，0.190）。接受麻醉监护的患者接受血管活性药物的比例显著更高（23.4%对49.5%，0.001），术中最低收缩压更低（134对123mmHg，0.046）。手术疗效、安全性、插管率和术后并发症无差异。
对于接受缺血性中风血管内血栓切除术的患者，围手术期采用护士实施的清醒镇静可能是安全有效的。
