Abstract W P12: Intra-procedural Hemodynamics in General Anesthesia versus Monitored Anesthesia Care During Endovascular Therapy for Acute Anterior Circulation Ischemic Stroke
Bibliographic record
Abstract
Background: Recent studies have identified general anesthesia (GA) as a predictor of poor outcome compared to non-intubated sedation techniques during intra-arterial therapy (IAT) for acute ischemic stroke (AIS). Factors contributing to this difference are not well understood. Objective: Identify factors associated with poor outcome in patients receiving GA vs Monitored Anesthesia Care (MAC). We speculated that peri-procedural blood pressure (BP) may be influenced by anesthesia and could plausibly contribute to differences in outcome. Methods: 190 patients who underwent IAT for anterior circulation AIS from 1/2008 to 12/2012 were included. Patients <18 years of age and posterior circulation AIS were excluded. Demographics, NIHSS, IV tPA use, use of GA/MAC, thrombus location, recanalization grade, post-procedure intracranial hemorrhage (ICH), and 30-day outcomes were collected. Intra-procedural hemodynamics including maximum/minimum heart rate and systolic/diastolic/mean BP were collected. Primary outcomes were in-hospital mortality and good outcome (mRS 0-2) at 30 days. Secondary outcomes were successful recanalization (TICI 2b-3) and ICH (PH1+2) based on ECASS definitions. Results: There were 91 and 99 patients in the GA and MAC groups respectively. Baseline characteristics including NIHSS scores were similar between both groups. The GA group had more ICA terminus occlusions (39.1% vs 18.2%, p = 0.043). There was significantly higher mortality (25.8% vs 13.3%, p = 0.040) and a trend towards poorer outcome (14.9% vs 22.8% with mRS 0-2, p = 0.239) in the GA group. Successful recanalization was higher in the GA group (57.1% vs 47.5%, p = 0.182), but the rate of PH1+2 ICH was significantly higher in the GA group (26.3% vs 10.1%, p = 0.003). There were no significant differences in intra-procedural hemodynamics, prior to or after recanalization. GA was an independent predictor of mortality and PH1+2 ICH. Conclusions: Patients placed under GA prior to IAT appear to have a higher probability of mortality and a trend towards poorer outcome. Outcome differences do not seem to be related to hemodynamic factors. There were significantly higher number of ICHs in the GA group and this could potentially be the factor driving the difference between outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".