Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms.

Fischer, Corinne; Vulcu, Sonja; Goldberg, Johannes; Wagner, Franca; Rodriguez, Belén; Söll, Nicole; Mordasini, Pasquale; Haenggi, Matthias; Schefold, Joerg C.; Raabe, Andreas; Z'Graggen, Werner J. (2021). Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms. F1000Research, 10(417), p. 417. F1000 Research Ltd 10.12688/f1000research.52324.2

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Background: Delayed cerebral ischemia and cerebral vasospasm remain the leading causes of poor outcome in survivors of aneurysmal subarachnoid hemorrhage. Refractory cerebral vasospasms can be treated with endovascular vasodilator therapy, which can either be performed in conscious sedation or general anesthesia. The aim of this study is to compare the effect of the anesthesia modality on long-term clinical outcomes in patients undergoing endovascular vasodilator therapy due to cerebral vasospasm and hypoperfusion. Methods: Modified Rankin Scale (mRS) scores were retrospectively analyzed at time of discharge from the hospital and six months after aneurysmal subarachnoid hemorrhage. Additionally, National Institutes of Health Stroke Scale (NIHSS) was assessed 24 hours before, immediately before, immediately after, and 24 hours after endovascular vasodilator therapy, and at discharge and six months. Interventional parameters such as duration of intervention, choice and dosage of vasodilator and number of arteries treated were also recorded. Results: A total of 98 patients were included in this analysis and separated into patients who had interventions in conscious sedation, general anesthesia and a mix of both. Neither mRS at discharge nor at six months showed a significant difference for functionally independent outcomes (mRS 0-2) between groups. NIHSS before endovascular vasodilator therapy was significantly higher in patients receiving interventions in general anesthesia but did not differ anymore between groups six months after the initial bleed. Conclusion: This study did not observe a difference in outcome whether patients underwent endovascular vasodilator therapy in general anesthesia or conscious sedation for refractory cerebral vasospasms. Hence, the choice should be made for each patient individually.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Vulcu, Sonja; Goldberg, Johannes; Wagner, Franca; Rodriguez Galdin, Belén; Soell, Nicole; Mordasini, Pasquale; Hänggi, Matthias; Schefold, Jörg Christian; Raabe, Andreas and Z'Graggen, Werner Josef

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2046-1402

Publisher:

F1000 Research Ltd

Language:

English

Submitter:

Jsabelle Arni

Date Deposited:

09 Sep 2021 15:00

Last Modified:

12 Sep 2021 03:17

Publisher DOI:

10.12688/f1000research.52324.2

PubMed ID:

34394915

Uncontrolled Keywords:

Nimodipine Papaverine aneurysmal subarachnoid hemorrhage conscious sedation delayed cerebral ischemia functional outcome general anesthesia hypoperfusion

BORIS DOI:

10.48350/158352

URI:

https://boris.unibe.ch/id/eprint/158352

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