Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients

Hervé Quintard; Vincent Degos; Mikael Mazighi; Jérôme Berge; Pierre Boussemart; Russel Chabanne; Samy Figueiredo; Thomas Geeraerts; Yoann Launey; Ludovic Meuret; Jean-Marc Olivot; Julien Pottecher; Francesca Rapido; Sébastien Richard; Suzana Saleme; Virginie Siguret-Depasse; Olivier Naggara; Hugues De Courson; Marc Garnier

doi:10.1016/j.accpm.2022.101188

Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients

Anaesth Crit Care Pain Med. 2023 Feb;42(1):101188. doi: 10.1016/j.accpm.2022.101188. Epub 2023 Jan 1.

Authors

Hervé Quintard¹, Vincent Degos², Mikael Mazighi³, Jérôme Berge⁴, Pierre Boussemart⁵, Russel Chabanne⁶, Samy Figueiredo⁷, Thomas Geeraerts⁸, Yoann Launey⁹, Ludovic Meuret⁹, Jean-Marc Olivot¹⁰, Julien Pottecher¹¹, Francesca Rapido¹², Sébastien Richard¹³, Suzana Saleme¹⁴, Virginie Siguret-Depasse¹⁵, Olivier Naggara¹⁶, Hugues De Courson¹⁷, Marc Garnier¹⁸

Affiliations

¹ Division of Intensive Care, University Hospital of Geneva, Geneva, Switzerland. Electronic address: [email protected].
² Pitié-Salpetrière Hospital, Department of Anesthesia, Critical Care and Perioperative Care, 47-83, Boulevard de l'Hôpital, Sorbonne University, Groupe Recherche Clinique BIOSFAST, 47-83, Boulevard de l'Hopital, 75013 Paris, France.
³ Department of Neurology and Stroke Centre, Lariboisière Hospital, AP-HP, Paris University, Sorbonne Paris Cité, Département Hospitalo-Universistaire Neurovasc, Paris, France.
⁴ Department of Neuroradiology, CHU de Bordeaux, Bordeaux, France.
⁵ Neurosurgical Intensive Care Department, Lille University Hospital, France.
⁶ Department of Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand Cedex, France.
⁷ Université Paris-Saclay, AP-HP, Service d'Anesthésie-Réanimation et Médecine Périopératoire, Hôpital de Bicêtre, DMU 12 Anesthésie, Réanimation, Douleur, Le Kremlin-Bicêtre, France.
⁸ Pôle Anesthésie-Réanimation, Inserm, UMR 1214, Toulouse Neuroimaging Center, ToNIC, Université Toulouse, CHU de Toulouse, Toulouse, France.
⁹ Critical Care Unit, Department of Anaesthesia, Critical Care and Perioperative Medicine, University Hospital of Rennes, Rennes, France.
¹⁰ Acute Stroke Unit, Clinical Investigation Center and Toulouse Neuro Imaging Center, Toulouse University Medical Center, Toulouse, France.
¹¹ Anaesthesiology, Critical Care and Perioperative Medicine, Strasbourg University Hospital-EA3072, FMTS, Strasbourg, France.
¹² Department of Anesthesiology and Critical Care Medicine, Gui de Chauliac Hospital, Montpellier University Hospital Center, Montpellier, France.
¹³ Université de Lorraine, CHRU-Nancy, Service de Neurologie, Unité Neurovasculaire, CIC-P 1433, INSERMU1116, F-54000 Nancy, France.
¹⁴ Service de Neuroradiologie, CHU Dupuytren, 87000, Limoges, France.
¹⁵ Service d'Hématologie Biologique, Hôpital Lariboisière, Université Paris Cité,75010 Paris, France, UMR-S-1140 Innovations Thérapeutiques en Hémostase, Université Paris Cité, 75006 Paris, France.
¹⁶ Pediatric Radiology Department, Necker Enfants Malades & GHU Paris, Sainte-Anne Hospital, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, Université de Paris, 75015 Paris, France.
¹⁷ Department of Anaesthesiology and Critical Care Pellegrin, Bordeaux University Hospital, Université de Bordeaux, Institut National de la Santé et de la Recherche Médicale, UMR 1219, Bordeaux Population Health Research Center, CHU Bordeaux, Bordeaux, France.
¹⁸ Sorbonne Université, GRC 29, DMU DREAM, Service d'Anesthésie-Réanimation et Médecine Périopératoire Rive Droite, Paris, France.

PMID: 36599377
DOI: 10.1016/j.accpm.2022.101188

Abstract

Purpose: To provide recommendations for the anaesthetic and peri-operative management for thrombectomy procedure in stroke patients DESIGN: A consensus committee of 15 experts issued from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation, SFAR), the Association of French-language Neuro-Anaesthetists (Association des Neuro-Anesthésistes Réanimateurs de Langue Francaise, ANARLF), the French Neuro-Vascular Society (Société Francaise de Neuro-Vasculaire, SFNV), the French Neuro-Radiology Society (Société Francaise de Neuro-Radiologie, SFNR) and the French Study Group on Haemostasis and Thrombosis (Groupe Français d'Études sur l'Hémostase et la Thrombose, GFHT) was convened, under the supervision of two expert coordinators from the SFAR and the ANARLF. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were required to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence.

Methods: Four fields were defined prior to the literature search: (1) Peri-procedural management, (2) Prevention and management of secondary brain injuries, (3) Management of antiplatelet and anticoagulant treatments, (4) Post-procedural management and orientation of the patient. Questions were formulated using the PICO format (Population, Intervention, Comparison, and Outcomes) and updated as needed. Analysis of the literature was then conducted and the recommendations were formulated according to the GRADE methodology.

Results: The SFAR/ANARLF/SFNV/SFNR/GFHT guideline panel drew up 18 recommendations regarding anaesthetic management of mechanical thrombectomy procedures. Due to a lack of data in the literature allowing to conclude with high certainty on relevant clinical outcomes, the experts decided to formulate these guidelines as "Professional Practice Recommendations" (PPR) rather than "Formalized Expert Recommendations". After two rounds of rating and several amendments, a strong agreement was reached on 100% of the recommendations. No recommendation could be formulated for two questions.

Conclusions: Strong agreement among experts was reached to provide a sizable number of recommendations aimed at optimising anaesthetic management for thrombectomy in patients suffering from stroke.

Keywords: Guidelines; Management; Stroke; Thrombectomy.

Publication types

Practice Guideline

MeSH terms

Anesthesia*
Anesthetics*
Critical Care / methods
Humans
Stroke* / surgery
Thrombectomy

Substances

Anesthetics