Abstract SNACC-82

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Predictors of Good Outcome in Patients Undergoing Endovascular Treatment of Acute Ischemic Stroke under General Anesthesia

Athiraman U, Nair B, Qurraie A, Becker K, Ghodke B, Hallam D, Kim L, Tirschwell D, Sharma D
University of Washington, Seattle, Washington, USA

Introduction: Multiple studies report an association of general anesthesia (GA) with poor outcomes in patients undergoing endovascular treatment of acute ischemic stroke (AIS). It is unclear however, which anesthetic factors impact outcomes. Specifically, the factors associated with good outcomes in patients receiving GA for endovascular treatment of AIS are unknown.
Aim: The aim of this retrospective study was to identify the factors associated with good outcomes in patients receiving GA for endovascular treatment of AIS.
Methods: Following IRB approval, patients > 18 years of age who underwent endovascular treatment of AIS under GA at Harborview Medical Center, a Comprehensive Stroke Center, from 2009-2013 were included. Patients who received local anesthesia / monitored anesthesia care and those for whom the electronic anesthesia record was unavailable, were excluded. Data sources were the institutional anesthesia database, stroke registry, and electronic medical and anesthesia records. Primary outcome measure was the modified Rankin Score (mRS). Good outcome was defined as mRS 0-2 and poor outcome as mRS 3-6. Independent t-test, Chi-square test and Fishers exact test were used to examine the association between the clinical characteristics and the outcomes. P<0.05 was considered statistically significant.
Results: 90 patients (58/32 M/F), aged 63±15 years were included. Anterior cerebral circulation was affected in 74(82%), and the median pre-procedural National Institute of Health Stroke Scale (NIHSS) score was 16 (1-38). Thirty-six (40%) and 21(24%) patients were on beta-blockers and ACE inhibitors, respectively. Overall, 20(22%) patients had good outcome (mRS 0-2). There was no difference between patients with good and poor outcome with respect to age, gender, stroke territory, anesthetic agents and duration of SBP < 140 mmHg under GA. There was also no difference in associated medical co-morbidities (renal insufficiency, diabetes, coronary artery disease), smoking, or post-procedural hemorrhage. Table 1 lists the clinical characteristics that were significantly different between patients with good and poor outcomes based on mRS (p<0.05).
Conclusion: In this series, patients with good outcome (mRS 0-2) had lower pre-procedure NIHSS score, higher average end-tidal CO2 and highest end-tidal CO2 under GA compared to the patients with poor outcome (mRS 3-6). Fewer patients with mRS 0-2 were intubated prior to start of anesthesia while more patients with mRS 0-2 were extubated at the end of procedure and were on beta-blockers prior to the stroke. Despite a potential selection bias and the retrospective nature of the study, these data indicate that in patients receiving GA, ventilation management including management of CO2 and extubation at the end of procedure may impact patient outcomes. These findings need confirmation in larger studies.

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