Reader response: Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry
YaoTang, Doctor, Department of Neurology, Chengdu Shang Jin Nan Fu Hospital (Chengdu, China)
Submitted January 02, 2020
We read the article by Goldhoorn et al.1 with great interest. Like the previous studies,2 the patients with local anesthesia (LA) only had lower baseline NIHSS scores, higher ASPECTS, and earlier to start of endovascular treatment and reperfusion. We think the question is not which anesthetic technique is better in a group of patients, but: is more suitable for a particular patient?
Why do we choose general anesthesia (GA)? For patients with higher NIHSS—who are irritable, not coordinated, or hemodynamically unstable—GA is preferred.2 Since the procedure may not be completed because of incoordination with LA, even need the assistant fixing and pressing the patient’s head. The concerns of GA are mainly time consuming, massive dosage of sedation drugs and hemodynamic problems, which could be solved and reduced by a trained anesthesia team.
The study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS1. The conclusion may be misunderstood by public readers, because no studies and trials address the question: why the procedures need GA and whether the procedures could be completed quickly without GA. Therefore, prospective randomized trials are needed to solve the problems mentioned above.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Goldhoorn RB, Bernsen MLE, Hofmeijer J. Anesthetic management during endovascular treatment of acute ischemic stroke in the MR CLEAN Registry. Neurology. 2020;94:e97–e106.
Anastasian ZH. Anaesthetic management of the patient with acute ischaemic stroke. Br J Anaesth. 2014;113 Suppl 2:ii9–ii16.
We read the article by Goldhoorn et al.1 with great interest. Like the previous studies,2 the patients with local anesthesia (LA) only had lower baseline NIHSS scores, higher ASPECTS, and earlier to start of endovascular treatment and reperfusion. We think the question is not which anesthetic technique is better in a group of patients, but: is more suitable for a particular patient?
Why do we choose general anesthesia (GA)? For patients with higher NIHSS—who are irritable, not coordinated, or hemodynamically unstable—GA is preferred.2 Since the procedure may not be completed because of incoordination with LA, even need the assistant fixing and pressing the patient’s head. The concerns of GA are mainly time consuming, massive dosage of sedation drugs and hemodynamic problems, which could be solved and reduced by a trained anesthesia team.
The study provides Class III evidence that for patients with acute ischemic stroke undergoing EVT, LA improves functional outcome compared to GA or CS1. The conclusion may be misunderstood by public readers, because no studies and trials address the question: why the procedures need GA and whether the procedures could be completed quickly without GA. Therefore, prospective randomized trials are needed to solve the problems mentioned above.
Disclosure
The author reports no relevant disclosures. Contact journal@neurology.org for full disclosures.
References