Deans' stroke musings: Management of Acute Ischemic Stroke–Specific Focus on Anesthetic Management for Mechanical Thrombectomy

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, May 5, 2021

Management of Acute Ischemic Stroke–Specific Focus on Anesthetic Management for Mechanical Thrombectomy

Notice the weasel word of 'management' NOT RECOVERY OR CURE. Managing implies they really don't know what they are doing just yet. As a businessperson I would never allow management of something to be in any of your goals. I would demand results being measured and proven to occur.

Management of Acute Ischemic Stroke–Specific Focus on Anesthetic Management for Mechanical Thrombectomy

Businger, Jerrad DO^*; Fort, Alexander C. MD^†; Vlisides, Phillip E. MD^‡; Cobas, Miguel MD, FCCM^†; Akca, Ozan MD, FCCM^§

Author Information

Anesthesia & Analgesia: October 2020 - Volume 131 - Issue 4 - p 1124-1134

doi: 10.1213/ANE.0000000000004959

Abstract

Acute ischemic stroke is a neurological emergency with a high likelihood of morbidity, mortality, and long-term disability. Modern stroke care involves multidisciplinary management by neurologists, radiologists, neurosurgeons, and anesthesiologists. Current American Heart Association/American Stroke Association (AHA/ASA) guidelines recommend thrombolytic therapy with intravenous (IV) alteplase within the first 3–4.5 hours of initial stroke symptoms and endovascular mechanical thrombectomy within the first 16–24 hours depending on specific inclusion criteria. The anesthesia and critical care provider may become involved for airway management due to worsening neurologic status or to enable computerized tomography (CT) or magnetic resonance imaging (MRI) scanning, to facilitate mechanical thrombectomy, or to manage critical care of stroke patients. Existing data are unclear whether the mechanical thrombectomy procedure is best performed under general anesthesia or sedation. Retrospective cohort trials favor sedation over general anesthesia, but recent randomized controlled trials (RCT) neither suggest superiority nor inferiority of sedation over general anesthesia. Regardless of anesthesia type, a critical element of intraprocedural stroke care is tight blood pressure management. At different phases of stroke care, different blood pressure targets are recommended. This narrative review will focus on the anesthesia and critical care providers’ roles in the management of both perioperative stroke and acute ischemic stroke with a focus on anesthetic management for mechanical thrombectomy.