Best practice in stroke anesthesiology

4 october 2016 – 8:30

Presentation 1

Anesthesia for intraarterial therapy in acute ischemic stroke
William Guillaume Taylor
Department of Anesthesiology and Resuscitation
Fondation Ophtalmologique Rothschild
Paris, France

After many years of using general anesthesia (GA) as a first-line strategy in the endovascular treatment of stroke (EST), an evolution in our thinking has taken place. Join Paris anesthesiologist G. Taylor as he leads us through this fundamental overview of where we stand today. Beginning with the revelation of a 2010 paper which showed GA as an independent predictor of poor outcome after endovascular therapy for acute ischemic stroke, learn why this was an “historic shock for anesthesiologists”. What was the clinical reaction among specialists and why, even today, do the recently updated AHA guidelines still advise against using GA as a first line strategy? Does the data support this? What subgroup analysis from the MR CLEAN trial points to different results in mechanical thrombectomies? Learn about a new French trial entitled GASS which will try to tease out the data behind these questions and see whether the reputation that “neurologists and interventional neuroradiologists live in fear of anesthesia” might not have any foundation…

Presentation 2

Best Practice in Stroke Anesthesiology
Julien Fendeleur
Department of Anesthesiology and Resuscitation
Hôpital Gui de Chauliac
Montpellier, France

Beginning with data from the Journal of NeuroInterventional Surgery showing the prominence of general anesthesia (GA) before 2015, J. Fendeleur leads us through a review of the publications that led to the present use of conscious sedation (CS) or non-GA. How does the question of whether an acute endovascular stroke is high, intermediate or low risk affect the anesthesiologist’s decision-making? Questions such as the importance of timing, the role of intubation or what changes in blood pressure can be expected or avoided are discussed. The role of allergy or hypersensitivity is considered. The role played by maintaining the penumbra or collateral circulation in choosing between GA and non-GA is discussed. Finally, a review of the four points for proper GA: speed, normocapnia, avoiding blood pressure drops and maintaining cardiac output/cerebral blood flow, completes this engaging presentation…

Presentation 3

Airway and sedation for thrombectomy: The SIESTA experience
Julian Bösel (PI)
Department of Neurology, University of Heidelberg
Heidelberg, Germany

What is happening during general or local anesthesia? Is your patient calm or agitated? These are the crucial question with which J. Bösel begins this fascinating presentation on his center’s attempt to find answers to these challenging questions. What are the reasons behind why many interventionalists today prefer general anesthesia (GA) – are these merely subjective or based on solid current evidence? What is the data breakdown between patients undergoing GA vs. conscious sedation (CS)? And what are the current recommendations in endovascular treatment of acute ischemic stroke? Here we look at details such as the case of CO2 after inadvertent hyperventilation or the physiologic targets aimed for at the Heidelberg center. Find out preliminary results concerning the 150 randomized patients, including the exclusion criteria, conversion rates from CS to GA and eventual follow-up. Was the experience definitive? Was CS proven to be superior to GA? Have we ended the debate about whether GA or CS should be used in endovascular stroke treatment (EST)? Learn the details of the Heidelberg “real-life” prospective study here…

 

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