Mode of Sedation During Endovascular Treatment of Vertebrobasilar Stroke
University Hospital Heidelberg
128 participants
Oct 1, 2022
INTERVENTIONAL
Conditions
Summary
Optimal anesthetic mode is not established for patients with vertebrobasilar stroke undergoing endovascular treatment. We want to investigate whether a procedural sedation mode approach is feasible compared to general anesthesia
Eligibility
Inclusion Criteria5
- Decision for thrombectomy according to local protocol for acute recanalizing stroke treatment
- Age 18 years or older, either sex
- National Institutes of Health Stroke Scale (NIHSS) ≥ 4
- Acute ischemic stroke in the posterior circulation with isolated or combined occlusion of vertebral artery (VA) and basilar artery (BA)
- Informed consent by the patient him-/herself or his/her legal representative obtainable within 72 h of treatment (deferred consenting procedure)
Exclusion Criteria5
- Intracerebral hemorrhage
- Coma on admission (Glasgow Coma Scale ≤ 8)
- Severe respiratory instability, loss of airway protective reflexes or vomiting on admission, where primary intubation and general anesthesia is deemed necessary
- Intubated state before randomization
- Severe hemodynamic instability (e.g. due to decompensated cardiac insufficiency)
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Interventions
Patients randomized to the GA arm are intubated after anesthetic induction. For this purpose, they are pre-oxygenated with an oxygen mask and non-invasive monitoring is established. After sufficient pre-oxygenation has been applied, analgesic and sedative medication are administered. If the patient is sufficiently long nil by mouth they are manually ventilated before a muscle relaxant is administered. A rapid-sequence induction is performed with administration of an opioid, sedative and muscle relaxant in rapid succession and without intermediate manual ventilation in non-nil by mouth patients. To secure the airway, an endotracheal tube is inserted into the trachea with the aid of a laryngoscope. After insertion of the endotracheal tube, its endotracheal position is confirmed with auscultation and capnography. GA maintenance therapy with opioids, sedatives and catecholamines, if needed, will then be started.
Locations(1)
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NCT05525325