Abstract
BACKGROUND AND PURPOSE
Whether general anesthesia for neurothrombectomy in patients with ischemic stroke has a negative impact on clinical outcome is currently under discussion. We investigated the impact of early extubation and ventilation duration in a cohort that underwent thrombectomy under general anesthesia.
MATERIALS AND METHODS
We analyzed 103 consecutive patients from a prospective stroke registry. They met the following criteria: CTA-proved large-vessel occlusion in the anterior circulation, ASPECTS above 6 on presenting cranial CT, revascularization by thrombectomy with the patient under general anesthesia within 6 hours after onset of symptoms, and available functional outcome (mRS) 90 days after onset.
RESULTS
The mean ventilation time was 128.07 ± 265.51 hours (median, 18.5 hours; range, 1–1244.7 hours). Prolonged ventilation was associated with pneumonia during hospitalization and unfavorable functional outcome (mRS ≥3) and death at follow-up (Mann-Whitney U test; P ≤ .001). According to receiver operating characteristic analysis, a cutoff after 24 hours predicted unfavorable functional outcome with a sensitivity and specificity of 60% and 78%, respectively. Our results imply that delayed extubation was not associated with a less favorable clinical outcome compared with immediate extubation after the procedure.
CONCLUSIONS
Short ventilation times are associated with a lower pneumonia rate and more favorable clinical outcome. Cautious interpretation of our data implies that whether patients are extubated immediately after the procedure is irrelevant for clinical outcome as long as ventilation does not exceed 24 hours.
Read this article: http://bit.ly/28L2GKo
Fellows’ Journal Club
The authors investigated the impact of early extubation and ventilation duration in a cohort of 103 patients that underwent thrombectomy under general anesthesia. Prolonged ventilation was associated with pneumonia during hospitalization and unfavorable functional outcome (mRS greater than or equal to 3) and death at follow-up. According to ROC analysis, a cutoff after 24 hours predicted unfavorable functional outcome with a sensitivity and specificity of 60% and 78%, respectively. The authors conclude that short ventilation times are associated with a lower pneumonia rate and more favorable clinical outcome.