General anesthesia versus conscious sedation in mechanical thrombectomy

BACKGROUND AND PURPOSE Anesthesia regimen in patients undergoing mechanical thrombectomy (MT) is still an unresolved issue. METHODS We compared the effect of anesthesia regimen using data from the German Stroke Registry-Endovascular Treatment (GSR-ET) between June 2015 and December 2019. Degree of disability was rated by the modified Rankin Scale (mRS), and good outcome was defined as mRS 0-2. Successful reperfusion was assumed when the modified thrombolysis in cerebral infarction scale was 2b-3. RESULTS Out of 6,635 patients, 67.1% (n=4,453) patients underwent general anesthesia (GA), 24.9% (n=1,650) conscious sedation (CS), and 3.3% (n=219) conversion from CS to GA. Rate of successful reperfusion was similar across all three groups (83.0% vs. 84.2% vs. 82.6%, P=0.149). Compared to the CA-group, the GA-group had a delay from admission to groin (71.0 minutes vs. 61.0 minutes, P\textless0.001), but a comparable interval from groin to flow restoration (41.0 minutes vs. 39.0 minutes). The CS-group had the lowest rate of periprocedural complications (15.0% vs. 21.0% vs. 28.3%, P\textless0.001). The CS-group was more likely to have a good outcome at follow-up (42.1% vs. 34.2% vs. 33.5%, P\textless0.001) and a lower mortality rate (23.4% vs. 34.2% vs. 26.0%, P\textless0.001). In multivariable analysis, GA was associated with reduced achievement of good functional outcome (odds ratio OR, 0.82; 95{\%} confidence interval CI, 0.71 to 0.94; P=0.004) and increased mortality (OR, 1.42; 95{\%} CI, 1.23 to 1.64; P{\textless}0.001). Subgroup analysis for anterior circulation strokes (n=5,808) showed comparable results. CONCLUSIONS We provide further evidence that CS during MT has advantages over GA in terms of complications, time intervals, and functional outcome

Oscillometric versus invasive blood pressure measurement in patients with shock: a prospective observational study in the emergency department

In emergency medicine, blood pressure is often measured by an oscillometric device using an upper arm cuff. However, measurement accuracy of this technique in patients suffering from hypotensive shock has not been sufficiently evaluated. We designed a prospective observational study investigating the accuracy of an oscillometric device in hypotensive patients admitted to the resuscitation area of the emergency department. Patients admitted to the resuscitation area of a university hospital, who were equipped with an arterial catheter and found to be hypotensive (mean arterial pressure (MAP) < 60 mmHg) were eligible for the study. Blood pressure was measured simultaneously via upper arm cuff and invasively under routine clinical conditions. After data extraction, Bland-Altman analysis, correlation coefficient and percentage error of mean and systolic blood pressure pairs were performed. We analysed 75 simultaneously obtained blood pressure measurements of 30 patients in hypotension, 11 (37%) were female, median age was 76.5 years (IQR 63-82). Oscillometric MAP was markedly higher than invasive MAP with a mean of the differences of 13 ± 15 mmHg (oscillometric-invasive), 95% limits of agreement - 16 to 41 mmHg, percentage error was 76%. In 64% of readings, values obtained by the upper arm cuff were not able to detect hypotension. Oscillometric blood pressure measurement is not able to reliably detect hypotension in emergency patients. Therefore, direct measurement of blood pressure should be established as soon as possible in patients suffering from shock