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David F Kallmes - One of the best experts on this subject based on the ideXlab platform.

  • association of local anesthesia versus Conscious Sedation with functional outcome of acute ischemic stroke patients undergoing embolectomy
    Interventional Neuroradiology, 2020
    Co-Authors: Joseph T Marion, Alejandro A Rabinstein, David F Kallmes, Seyed Mohammad Seyedsaadat, Jeffery J Pasternak, Waleed Brinjikji
    Abstract:

    PurposeCompare functional outcomes of acute ischemic stroke patients undergoing embolectomy with either local anesthesia or Conscious Sedation. Secondarily, identify differences in hemodynamic para...

  • Conscious Sedation versus general anaesthesia during mechanical thrombectomy for stroke a propensity score analysis
    Journal of NeuroInterventional Surgery, 2015
    Co-Authors: Jennifer S Mcdonald, Waleed Brinjikji, Alejandro A Rabinstein, Harry J Cloft, Giuseppe Lanzino, David F Kallmes
    Abstract:

    Background Debate exists as to whether patients with acute ischemic stroke who are undergoing mechanical thrombectomy should receive general anaesthesia or Conscious Sedation during the procedure. Using a multihospital administrative database, we compared outcomes and complications of patients receiving mechanical thrombectomy, who were receiving general anaesthesia and Conscious Sedation, and studied trends in usage over time. Materials and methods Premier database patients who underwent mechanical thrombectomy from 2006 to 2013 for acute ischemic stroke were identified. Using propensity score analysis, recipients of general anaesthesia and Conscious Sedation underwent 1:1 matching. Outcomes including usage trends, discharge status, mortality, length of stay, haemorrhage and pneumonia were examined. Results A total of 2512 patients receiving mechanical thrombectomy were identified. 1999 (80%) received general anaesthesia and 513 (20%) received Conscious Sedation. Following 1:1 matching by the propensity score matching, 507 general anaesthesia and 507 Conscious Sedation patients were matched. Patients who received general anaesthesia during their procedure had significantly higher rates of in-hospital mortality (25% vs 12%, OR=2.37 95% CI 1.68 to 3.37, p Conclusions In our cohort, thrombectomy patients receiving Conscious Sedation have decreased in-hospital mortality, decreased rates of pneumonia, and lower hospital costs and lengths of stay when compared with patients who received general anaesthesia. However, most practitioners continue to use general anaesthesia in the setting of acute stroke interventions.

  • Conscious Sedation versus general anesthesia during endovascular acute ischemic stroke treatment a systematic review and meta analysis
    American Journal of Neuroradiology, 2015
    Co-Authors: Waleed Brinjikji, Alejandro A Rabinstein, Harry J Cloft, Giuseppe Lanzino, Mohammad Hassan Murad, David F Kallmes
    Abstract:

    BACKGROUND AND PURPOSE: A number of studies have suggested that anesthesia type (Conscious Sedation versus general anesthesia) during intra-arterial treatment for acute ischemic stroke has implications for patient outcomes. We performed a systematic review and meta-analysis of studies comparing the clinical and angiographic outcomes of the 2 anesthesia types. MATERIALS AND METHODS: In March 2014, we conducted a computerized search of MEDLINE and EMBASE for reports on anesthesia and endovascular treatment of acute ischemic stroke. Using random-effects meta-analysis, we evaluated the following outcomes: recanalization rate, good functional outcome (mRS ≤ 2), asymptomatic and symptomatic intracranial hemorrhage, death, vascular complications, respiratory complications, procedure time, time to groin, and time from symptom onset to recanalization. RESULTS: Nine studies enrolling 1956 patients (814 with general anesthesia and 1142 with Conscious Sedation) were included. Compared with patients treated by using Conscious Sedation during stroke intervention, patients undergoing general anesthesia had higher odds of death (OR = 2.59; 95% CI, 1.87–3.58) and respiratory complications (OR = 2.09; 95% CI, 1.36–3.23) and lower odds of good functional outcome (OR = 0.43; 95% CI, 0.35–0.53) and successful angiographic outcome (OR = 0.54; 95% CI, 0.37–0.80). No difference in procedure time (P = .28) was seen between the groups. Preintervention NIHSS scores were available from 6 studies; in those, patients receiving general anesthesia had a higher average NIHSS score. CONCLUSIONS: Patients with acute ischemic stroke undergoing intra-arterial therapy may have worse outcomes with general anesthesia compared with Conscious Sedation. However, the difference in stroke severity at the onset may confound the comparison in the available studies; thus, a randomized trial is necessary to confirm this association.

David Cohen - One of the best experts on this subject based on the ideXlab platform.

Mehmet Cilingiroglu - One of the best experts on this subject based on the ideXlab platform.

  • effectiveness and safety of same day discharge after left atrial appendage closure under moderate Conscious Sedation
    Catheterization and Cardiovascular Interventions, 2021
    Co-Authors: Konstantinos Marmagkiolis, Ismail Ates, Gulcan Kose, Cezar Iliescu, Mehmet Cilingiroglu
    Abstract:

    Background Left atrial appendage occlusion (LAAO) using Watchman device has become a world-wide, well-established therapeutic alternative to chronic systemic oral anticoagulation in patient who are at high-risk of bleeding with paroxysmal (PAF) or chronic atrial fibrillation (Afib). Currently, LAAO procedures are performed under general anesthesia (GA) and patients stay overnight post procedure in the United States. We aimed to present the effectiveness and safety of same day discharge following LAAO under moderate Conscious Sedation (MCS) in patients without procedural complications. Methods A total of 112 patients between August 2019 and May 2020 with elevated CHA2 DS2 VASc (median score of 3) underwent transesophageal echocardiography (TEE)-guided LAAO with FDA approved Watchman (Boston Scientific, MN) under MCS and discharged home on the same day 6 hr following their post procedural transthoracic echocardiogram (TTE) evaluations. All patients had next day TTE and follow up at the cardiology clinic. We prospectively evaluated clinical and procedural outcomes using medical records of these patients. Results Among all the patients, the mean age was 83.5 ± 8.5 years, 45 (40%) were women. Procedural duration, device implant time and fluoroscopic times were 45 ± 8.6, 14.5 ± 7.8 and 10.2 ± 1.2 min, respectively. The median required dosage of propofol was 105 ± 2.8 mg. No complications arose from MCS. There was no need for conversion to GA in any of the patients during the procedure. All patients were able to be discharged 6 hr following their TTE evaluation post procedure. There were no procedural complications. Conclusions Same day discharge following LAAO closure seems to be safe and effective in patients without procedural complications. LAAO can also be performed safely and effectively under moderate Conscious Sedation. Applying moderate Conscious Sedation may simplify the LAAO procedure, reduce procedural time, procedural costs and hospital stay while increasing overall patient satisfaction.

O Doerr - One of the best experts on this subject based on the ideXlab platform.

Costanza Pellegrini - One of the best experts on this subject based on the ideXlab platform.