Abstract TP148: Anesthesia Protocol For Acute Ischemic Stroke Facilitates General Anesthesia In EVT And Optimizes Key Performance Measures

Abstract

Background: Currently, there is no consensus on the ideal anesthetic strategy for patients undergoing EVT for an LVO. Recently published clinical trials show no difference in mortality, recanalization, and functional outcome related to anesthetic technique, while ongoing trials look at treatment benefits in patients randomized to general anesthesia (GA) compared to conscious sedation during EVT. Utilizing a well-outlined standardized anesthesia protocol for GA in patients undergoing EVT can optimize key performance measures for EVT without adding unnecessary delays. Methods: This is a retrospective review of a prospectively collected database of patients who underwent EVT for LVO at a single academic CSC between January 2021 and August 2022. A multispecialty work group convened to outline best practices in the angio suite. All procedures were performed under GA while adhering to the “EVT Anesthesia Workflow.” The endorsed workflow outlined the protocol for notification of anesthesia and the angio team; the responsibility for order placements, request for bed, and procedural consent; and the expectations for all teams members to have lead on prior to patient arrival to the angio suite with biplane placement so that groin access could be obtained concurrently with intubation, to perform all cases under GA if deemed appropriate by anesthesia (unless requested otherwise), and that arterial line monitoring should not delay the procedure start time. Furthermore, pre and intraprocedural blood pressure parameters and post-EVT blood pressure goals were outlined. Results: A total of 102 patients were reviewed, all underwent general anesthesia (5% were intubated before angio suite arrival; n=5). Mode of arrival included 47 interfacility transfers, 35 primary facility ED, and 20 inpatients. The overall median angio door-to-intubation time was 6 minutes, and angio door-to-puncture was 10 minutes. The median puncture-to-device time was 24 minutes. Conclusion: A multispecialty collaboration to define agreed-upon workflows that outline responsibilities, expectations and goals can facilitate rapid treatments in an emergent setting. An EVT Anesthesia Workflow facilitated the use of GA in EVT without adding delays to key EVT performance measures.