Inhalational Versus Intravenous Anesthetic Conditioning for Subarachnoid Hemorrhage-Induced Delayed Cerebral Ischemia.
Inhalational Versus Intravenous Anesthetic Conditioning for Subarachnoid Hemorrhage-Induced Delayed Cerebral Ischemia.
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DOI：
10.1161/strokeaha.121.035075
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发表时间：
2022-03
期刊：
影响因子：
8.3
通讯作者：
Zipfel GJ
中科院分区：
文献类型：
--
作者：
Athiraman U;Lele AV;Karanikolas M;Dhulipala VB;Jayaraman K;Fong C;Kentner R;Sheolal R;Vellimana A;Gidday JM;Dhar R;Zipfel GJ
吸入麻醉剂与动脉瘤性蛛网膜下腔出血（SAH）患者血管造影血管痉挛和延迟性脑缺血（DCI）发生率降低相关。静脉麻醉药是否能提供类似程度的保护尚不清楚。回顾性收集2014年1月1日至2018年5月31日在美国两个学术中心（一个主要采用吸入麻醉，另一个主要采用异丙酚静脉麻醉）接受动脉瘤修复全麻的SAH患者的麻醉数据。我们比较了两个地点的血管造影血管痉挛、DCI和神经系统结果（通过出院时的处置来测量），并对潜在的混杂因素进行了调整。我们比较了179名在一家机构接受吸入麻醉剂的SAH患者和206名在另一家机构接受静脉麻醉剂的SAH患者。吸入麻醉组和静脉麻醉组血管造影血管痉挛的发生率分别为32%和52% (OR:0.49, CI:0.32-0.75, p=0.001)， DCI分别为21%和40% (OR:0.47, CI:0.29-0.74, p=0.001)，校正了不同部位/组、Hunt-Hess和Fisher分级、动脉瘤治疗类型和ASA状态之间的不平衡。麻醉药物对出院时的神经预后没有影响，吸入麻醉组和静脉麻醉组的出院预后良好率分别为78%和72% （p=0.23）。我们的数据表明，在动脉瘤破裂修复中接受吸入麻醉和静脉麻醉的患者对sah诱导的血管造影血管痉挛和DCI具有显著的保护作用。虽然我们在这项比较研究中不能完全区分部位特异性与麻醉剂的作用，但这些结果，再加上临床前数据显示吸入麻醉剂对血管痉挛和DCI具有类似的保护作用，表明吸入麻醉剂可能更适合接受动脉瘤修复的SAH患者。进一步研究吸入麻醉剂对其他SAH结果的影响，如早期脑损伤和长期神经系统结果是有必要的。
Inhalational anesthetics were associated with reduced incidence of angiographic vasospasm and delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (SAH) patients. Whether intravenous anesthetics provide similar level of protection is not known. Anesthetic data were collected retrospectively for SAH patients who received general anesthesia for aneurysm repair between January 1st, 2014 and May 31, 2018 at two academic centers in the United States (one employing primarily inhalational and the other primarily intravenous anesthesia with propofol). We compared the outcomes of angiographic vasospasm, DCI, and neurologic outcome (measured by disposition at hospital discharge), between the two sites, adjusting for potential confounders. We compared 179 SAH patients receiving inhalational anesthetics at one institution to 206 SAH patients receiving intravenous anesthetics at the second institution. The rates of angiographic vasospasm between inhalational vs intravenous anesthetic groups were 32% vs 52% (OR:0.49, CI:0.32-0.75, p=0.001) and DCI were 21% vs 40% (OR:0.47, CI:0.29-0.74, p=0.001), adjusting for imbalances between sites/groups, Hunt-Hess and Fisher grades, type of aneurysm treatment and ASA status. No impact of anesthetics on neurological outcome at time of discharge was noted with rates of good discharge outcome between inhalational vs intravenous anesthetic groups at (78% vs. 72%, p=0.23). Our data suggests that those who received inhalational vs. intravenous anesthetic for ruptured aneurysm repair had significant protection against SAH-induced angiographic vasospasm and DCI. Although we cannot fully disentangle site-specific vs. anesthetic effects in this comparative study, these results, when coupled with preclinical data demonstrating a similar protective effect of inhalational anesthetics on vasospasm and DCI, suggest that inhalational anesthetics may be preferable for SAH patients undergoing aneurysm repair. Additional investigations examining the effect of inhalational anesthetics on other SAH outcomes such as early brain injury and long-term neurological outcomes are warranted.
影响因子：
6.9
作者：
McLaughlin, BethAnn;Gidday, Jeff M.
通讯作者：
Gidday, Jeff M.