Application of Bundle Care in Patient with Individualized Sedation Care During the Interventional Therapy for Anterior-circulation Acute Ischemic Stroke

Lifang Chen,Peng Zhang,Jiancong Chen

doi:10.11648/j.ajns.20200902.18

Abstract

Objective: With the rapid development of interventional diagnosis and treatment technology and the shortage of nursing human resources, the workload of interventional surgery has increased dramatically. In the face of an increasing number of patients or emergency operations with potential sedation needs, especially in the emergency of AIS patients, the nurses are often responsible for the monitoring and nursing of sedated patients under the instructions of doctors. This paper aims to analyze and evaluate the effects of individualized sedation care during the interventional therapy for anterior-circulation Acute Ischemic Stroke (AIS). Methods: According to the actual situation, 106 patients were treated with sedation care, dynamic evaluating, medicating and restricting programmatically. And patients were grouped into 2 groups according to the sedation medication option, comparing the door-to-reperfusion time in the digital subtraction angiography (DSA) suite and occurrence of adverse reactions. Results: Nurses and doctors successfully cooperated during therapies. The door-to-reperfusion time in the DSA suite of the Midazolam Group and the Dexmedetomidine Group were 38.7±9.8 min and 38.4±10.9 min, which reached the reference level reported in the literature. The rates of adverse reactions were low and no death cases. There was no significant difference in blood oxygen desaturation, blood pressure decline, vomiting, sedation deficiency and over sedation between the two groups (<i>P</i>>0.05). But there were significant differences in image artifacts between the two groups (<i>P</i><0.05). Conclusion: With individualized sedation care, it can benefit to shorten the reperfusion time and provide safety for the emergency interventional therapy for AIS patients.

Highlights

The treatment of Acute Ischemic Stroke (AIS) is to recanalize blood vessels within the treatment time window, rescue reversible ischemic tissue and reduce the final infarct size
According to the latest guidelines [1], there is no significant difference in the prognosis between general anesthesia and non-general anesthesia in AIS patients with circulatory occlusion during thrombectomy, and individualized sedation is recommended according to specific conditions
By the principle of "Time is brain and every second counts”, the emergency interventional operation of AIS patients with anterior circulation occlusion is generally done without notice or waiting for anesthesiologists, and the sedation and nursing of patients are often undertaken by the interventional nurses under the instructions of doctors [2,3,4,5]

Summary

Introduction

The treatment of Acute Ischemic Stroke (AIS) is to recanalize blood vessels within the treatment time window, rescue reversible ischemic tissue and reduce the final infarct size. Symptoms of patients, for instance, confusion, agitation, and vomiting often delay the time of intravascular thrombectomy, in which sedation or anesthesia has, become an important step. By the principle of "Time is brain and every second counts”, the emergency interventional operation of AIS patients with anterior circulation occlusion is generally done without notice or waiting for anesthesiologists, and the sedation and nursing of patients are often undertaken by the interventional nurses under the instructions of doctors [2,3,4,5]. Bundle of care integrates a series of treatment and nursing measures based on evidence-based medicine, and an individualized sedation bundle of care is very important to ensure the safety of patients and shorten the time of emergency intravascular thrombectomy [6]. Our hospital has ripe operating experience in the green channel of AIS intervention, and the interventional surgery team has, through

Methods

Results

Conclusion