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Ετικέτες
Πέμπτη 20 Ιουλίου 2017
Τετάρτη 19 Ιουλίου 2017
Role of anesthesia in endovascular stroke therapy.
Purpose of review: Recent randomized clinical trials have demonstrated strong efficacy of endovascular therapy (EVT) for acute ischemic stroke (AIS) from large vessel occlusions; in the USA alone, tens of thousands of patients annually may benefit. The impact of the type of anesthesia used during mechanical thrombectomy on patient outcomes remains controversial. This review discusses the current literature on the effects of anesthesia type on patient outcome following endovascular stroke therapy. Recent findings: EVT is the standard of treatment for intracranial large vessel occlusions. Recent studies show that general anesthesia is associated with negative clinical outcome in AIS patients undergoing EVT. Two of the possible mechanisms of this finding are systolic hypotension and hypocapnia. However, the only published randomized controlled studies to date, sedation vs. intubation for endovascular stroke treatment and anesthesia during stroke showed no difference in short-term clinical outcome between EVT patients treated with general anesthesia and conscious sedation and improved longer-term outcome in the general anesthesia group. Summary: Retrospective reports, and the 2015 American Heart Association/American Stroke Association Guideline (focused update of the 2013 guidelines for the early management of patients with AIS regarding endovascular treatment) based on these reports, are in favor of sedation (conscious sedation) over general anesthesia for endovascular stroke thrombectomy. However, the two randomized controlled prospective studies published provide inconclusive evidence as to the best anesthetic practice for endovascular stroke therapy. More randomized clinical trials are needed to optimize anesthetic patient care in AIS. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2vlisYT
http://ift.tt/2vlisYT
Dermoscopy is useful for the diagnosis of milia-like idiopathic calcinosis cutis
http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12675
Survey of Australian dermatologists’ perceptions and experiences with isotretinoin-induced depression and suicide
http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12602
Eczema exacerbation caused by Coxsackie virus A6
http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12677
Mohs micrographic surgery using paraffin sections for the treatment of dermatofibroma of the face: A preliminary case series
http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Fajd.12601
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