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Anesthesia and Sedation Practices Among Neurointerventionalists during Acute Ischemic Stroke Endovascular Therapy.

McDonagh DL, Olson DM, Kalia JS, Gupta R, Abou-Chebl A, Zaidat OO - Front Neurol (2010)

Bottom Line: We aimed to better understand sedation practices in AIS.There was a preference for GA because of eliminating movement (65.3% of respondents; N = 32/49), perceived procedural safety (59.2%, N = 29/49), and improved procedural efficacy (42.9%, N = 21/49).Prior to making GA standard of care during AIS intervention, more data are needed about effects on clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Duke University Medical Center Durham, NC, USA.

ABSTRACT

Background and purpose: Intra-arterial reperfusion therapies are expanding frontiers in acute ischemic stroke (AIS) management but there is considerable variability in clinical practice. The use of general anesthesia (GA) is one example. We aimed to better understand sedation practices in AIS.

Methods: An online survey was distributed to the 68 active members of the Society of Vascular and Interventional Neurology (SVIN). Survey development was based on discussions at the SVIN Endovascular Stroke Round Table Meeting (Chicago, IL, 2008). The final survey contained 12 questions. Questions were developed as single and multiple-item responses; with an option for a free-text response.

Results: There was a 72% survey response rate (N = 49/68). Respondents were interventional neurologists in practice 1-5 years (71.4%, N = 35). The mean (±SD) AIS interventions performed per year at the respondents' institutions was 42.5 ± 25, median 35.0 (IQR 20, 60). The most frequent anesthesia type used was GA (anesthesia team), then conscious sedation (nurse administered), monitored anesthesia care (anesthesia team), and finally local analgesia alone. There was a preference for GA because of eliminating movement (65.3% of respondents; N = 32/49), perceived procedural safety (59.2%, N = 29/49), and improved procedural efficacy (42.9%, N = 21/49). However, cited limitations to GA included risk of time delay (69.4%, N = 34), of propagating cerebral ischemia due to hypoperfusion or other complications (28.6%, N = 14), and lack of adequate anesthesia workforce (20.4%, N = 7).

Conclusions: The most frequent type of anesthesia used by Neurointerventionalists for AIS interventions is GA. Prior to making GA standard of care during AIS intervention, more data are needed about effects on clinical outcomes.

No MeSH data available.


Related in: MedlinePlus

Averaged ratings of physician's frequency of use for four types of anesthesia. *Treated as ordinal where 1 = Never, 2 = Least frequent, 3 = Frequent, 4 = Most frequent.
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Figure 1: Averaged ratings of physician's frequency of use for four types of anesthesia. *Treated as ordinal where 1 = Never, 2 = Least frequent, 3 = Frequent, 4 = Most frequent.

Mentions: The final survey was a set of 12 questions (Appendix 1) agreed upon by consensus from the investigational team. Questions were developed as single-item and multiple-item responses. Additionally, the option for a free-text response was included where applicable. Survey Monkey™ was used to distribute the survey and collect responses. Respondents were asked to rate some items on an ordinal scale of: never, least frequent, frequent, most frequent. In summarizing this data in Figure 1, the ordinal data was converted to a 1 through 4 numeric scale. The “average rating” in Figure 1 refers to the average score on this numeric scale. Statistical analysis was performed using SAS v9.1 for Windows software (Cary, NC, USA). Missing values were treated as , imputation was not used.


Anesthesia and Sedation Practices Among Neurointerventionalists during Acute Ischemic Stroke Endovascular Therapy.

McDonagh DL, Olson DM, Kalia JS, Gupta R, Abou-Chebl A, Zaidat OO - Front Neurol (2010)

Averaged ratings of physician's frequency of use for four types of anesthesia. *Treated as ordinal where 1 = Never, 2 = Least frequent, 3 = Frequent, 4 = Most frequent.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3008915&req=5

Figure 1: Averaged ratings of physician's frequency of use for four types of anesthesia. *Treated as ordinal where 1 = Never, 2 = Least frequent, 3 = Frequent, 4 = Most frequent.
Mentions: The final survey was a set of 12 questions (Appendix 1) agreed upon by consensus from the investigational team. Questions were developed as single-item and multiple-item responses. Additionally, the option for a free-text response was included where applicable. Survey Monkey™ was used to distribute the survey and collect responses. Respondents were asked to rate some items on an ordinal scale of: never, least frequent, frequent, most frequent. In summarizing this data in Figure 1, the ordinal data was converted to a 1 through 4 numeric scale. The “average rating” in Figure 1 refers to the average score on this numeric scale. Statistical analysis was performed using SAS v9.1 for Windows software (Cary, NC, USA). Missing values were treated as , imputation was not used.

Bottom Line: We aimed to better understand sedation practices in AIS.There was a preference for GA because of eliminating movement (65.3% of respondents; N = 32/49), perceived procedural safety (59.2%, N = 29/49), and improved procedural efficacy (42.9%, N = 21/49).Prior to making GA standard of care during AIS intervention, more data are needed about effects on clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Duke University Medical Center Durham, NC, USA.

ABSTRACT

Background and purpose: Intra-arterial reperfusion therapies are expanding frontiers in acute ischemic stroke (AIS) management but there is considerable variability in clinical practice. The use of general anesthesia (GA) is one example. We aimed to better understand sedation practices in AIS.

Methods: An online survey was distributed to the 68 active members of the Society of Vascular and Interventional Neurology (SVIN). Survey development was based on discussions at the SVIN Endovascular Stroke Round Table Meeting (Chicago, IL, 2008). The final survey contained 12 questions. Questions were developed as single and multiple-item responses; with an option for a free-text response.

Results: There was a 72% survey response rate (N = 49/68). Respondents were interventional neurologists in practice 1-5 years (71.4%, N = 35). The mean (±SD) AIS interventions performed per year at the respondents' institutions was 42.5 ± 25, median 35.0 (IQR 20, 60). The most frequent anesthesia type used was GA (anesthesia team), then conscious sedation (nurse administered), monitored anesthesia care (anesthesia team), and finally local analgesia alone. There was a preference for GA because of eliminating movement (65.3% of respondents; N = 32/49), perceived procedural safety (59.2%, N = 29/49), and improved procedural efficacy (42.9%, N = 21/49). However, cited limitations to GA included risk of time delay (69.4%, N = 34), of propagating cerebral ischemia due to hypoperfusion or other complications (28.6%, N = 14), and lack of adequate anesthesia workforce (20.4%, N = 7).

Conclusions: The most frequent type of anesthesia used by Neurointerventionalists for AIS interventions is GA. Prior to making GA standard of care during AIS intervention, more data are needed about effects on clinical outcomes.

No MeSH data available.


Related in: MedlinePlus