Abstract Details

Title Monitored anesthesia care by sedation-trained providers in acute stroke thrombectomy.

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-015

Objective To compare outcomes for acute stroke thrombectomy with conscious sedation managed by either anesthesia teams or sedation-trained interventionists.

Background Mechanical thrombectomy (MT) for ischemic stroke can be performed under local anesthesia (LA), conscious sedation (CS), or general anesthesia (GA). The need for monitoring by anesthesia providers may be resource intensive. We sought to determine differences in outcomes of MT when sedation is performed by an anesthesia team compared to sedation-trained providers.

Design/Methods We performed a retrospective analysis on patients who were screened by a pre-hospital stroke severity screening tool and underwent MT at two stroke centers. Baseline characteristics, time metrics, sedatives, peri-procedural intubation, complications and outcomes were recorded. Good outcome was defined as modified Rankin score of ≤ 2.

Results We analyzed 104 patients (sedation-trained provider = 63, anesthesia team = 41) between July 2015 and December 2017. In the sedation-trained provider group, four patients required intervention by an anesthesia team. There were no differences in patients receiving LA (sedation-trained provider 24% versus anesthesia team 27% p=0.82), CS (70% versus 63%, p=0.53), or GA (6% versus 10%, p=0.71) between groups. Sedation-trained providers were more likely to use only one drug during the procedure (62% vs 34%, p=0.009). The rate of procedural complications (10% vs 5%, p=0.48), good outcome (56% vs. 39%, p=0.11), and mortality (22% vs 24%, p=0.82) was similar between groups. Sedation by provider type did not predict functional outcome or mortality at three months.

Conclusions Sedation-trained providers are capable of delivering appropriate sedation without compromising patient safety. The use of ‘as needed’ anesthesia teams for MT may have considerable effect on resource allocation and cost.

Authors/Disclosures
Diana E. Slawski, MD (Stanford University Healthcare) PRESENTER	No disclosure on file
Hisham Salahuddin, MD	Dr. Salahuddin has nothing to disclose.
	No disclosure on file
Syed F. Zaidi, MD (ProMedica Stroke Network)	Dr. Zaidi has nothing to disclose.
Mouhammad A. Jumaa, MD (ProMedica Stroke Network)	Dr. Jumaa has nothing to disclose.

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