Association of intraprocedural blood pressure and end tidal carbon dioxide with outcome after acute stroke intervention

Courtney Takahashi, Ansgar Brambrink, Michael Aziz, Elizabeth Macri, Joshua Raines, Anmol Multani-Kohol, Holly Hinson, Helmi Lutsep, Wayne Clark, Jeremy D. Fields

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background: General anesthesia (GA) for acute stroke interventions may be associated with inferior functional outcomes. Our goal was to identify physiologic parameters that mediate this association. Methods: Consecutive patients treated at our institution between August 2007 and December 2010 were identified from a prospective database. Clinical data were then extracted by retrospective chart review. Variables significantly associated with outcome in univariate analysis were also examined in multivariate analysis, controlling for well-established prespecified predictors of functional outcome. Results: Of the 106 patients identified, 20 were excluded (17 due to the absence of 90-day mRS and 3 due to insufficient anesthetic records). Blood pressure (BP) decreased significantly after induction of GA, but there was no association between BP and outcome. End tidal carbon dioxide values (ETCO2) at 60 and 90 min, however, were significantly associated with outcomes in both univariate and multivariate analyses. Mean ETCO2 in patients with favorable outcomes (modified Rankin Scale (mRS) 0-3) was higher than in those with unfavorable outcomes (mRS 4-6): 35.2 mmHg versus 32.2 (p = 0.03) at 60 min and 34.9 versus 31.9 (p = 0.04) at 90 min. The adjusted odds ratios for poor outcomes for each 1 mmHg decrease in ETCO2 were the same: 0.76 (95 % CI 0.65-0.92; p = 0.004) at 60 min and 0.76 (95 % CI 0.61-0.93; p = 0.01) at 90 min. Conclusions: While BP decreased significantly in patients undergoing GA for acute stroke intervention, it did not correlate with patient outcome. Decreases in ETCO2 at 30 and 60 min, however, were associated with 90-day mRS.

Original languageEnglish (US)
Pages (from-to)202-208
Number of pages7
JournalNeurocritical Care
Volume20
Issue number2
DOIs
StatePublished - 2014

Fingerprint

Carbon Dioxide
Stroke
Blood Pressure
General Anesthesia
Multivariate Analysis
Anesthetics
Odds Ratio
Databases

Keywords

  • Anesthesia
  • Blood pressure
  • End-tidal carbon dioxide
  • Endovascular
  • Stroke
  • Ventilation

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Association of intraprocedural blood pressure and end tidal carbon dioxide with outcome after acute stroke intervention. / Takahashi, Courtney; Brambrink, Ansgar; Aziz, Michael; Macri, Elizabeth; Raines, Joshua; Multani-Kohol, Anmol; Hinson, Holly; Lutsep, Helmi; Clark, Wayne; Fields, Jeremy D.

In: Neurocritical Care, Vol. 20, No. 2, 2014, p. 202-208.

Research output: Contribution to journalArticle

Takahashi, Courtney ; Brambrink, Ansgar ; Aziz, Michael ; Macri, Elizabeth ; Raines, Joshua ; Multani-Kohol, Anmol ; Hinson, Holly ; Lutsep, Helmi ; Clark, Wayne ; Fields, Jeremy D. / Association of intraprocedural blood pressure and end tidal carbon dioxide with outcome after acute stroke intervention. In: Neurocritical Care. 2014 ; Vol. 20, No. 2. pp. 202-208.
@article{522ddc9c9bf741b8a3a66f435f417482,
title = "Association of intraprocedural blood pressure and end tidal carbon dioxide with outcome after acute stroke intervention",
abstract = "Background: General anesthesia (GA) for acute stroke interventions may be associated with inferior functional outcomes. Our goal was to identify physiologic parameters that mediate this association. Methods: Consecutive patients treated at our institution between August 2007 and December 2010 were identified from a prospective database. Clinical data were then extracted by retrospective chart review. Variables significantly associated with outcome in univariate analysis were also examined in multivariate analysis, controlling for well-established prespecified predictors of functional outcome. Results: Of the 106 patients identified, 20 were excluded (17 due to the absence of 90-day mRS and 3 due to insufficient anesthetic records). Blood pressure (BP) decreased significantly after induction of GA, but there was no association between BP and outcome. End tidal carbon dioxide values (ETCO2) at 60 and 90 min, however, were significantly associated with outcomes in both univariate and multivariate analyses. Mean ETCO2 in patients with favorable outcomes (modified Rankin Scale (mRS) 0-3) was higher than in those with unfavorable outcomes (mRS 4-6): 35.2 mmHg versus 32.2 (p = 0.03) at 60 min and 34.9 versus 31.9 (p = 0.04) at 90 min. The adjusted odds ratios for poor outcomes for each 1 mmHg decrease in ETCO2 were the same: 0.76 (95 {\%} CI 0.65-0.92; p = 0.004) at 60 min and 0.76 (95 {\%} CI 0.61-0.93; p = 0.01) at 90 min. Conclusions: While BP decreased significantly in patients undergoing GA for acute stroke intervention, it did not correlate with patient outcome. Decreases in ETCO2 at 30 and 60 min, however, were associated with 90-day mRS.",
keywords = "Anesthesia, Blood pressure, End-tidal carbon dioxide, Endovascular, Stroke, Ventilation",
author = "Courtney Takahashi and Ansgar Brambrink and Michael Aziz and Elizabeth Macri and Joshua Raines and Anmol Multani-Kohol and Holly Hinson and Helmi Lutsep and Wayne Clark and Fields, {Jeremy D.}",
year = "2014",
doi = "10.1007/s12028-013-9921-3",
language = "English (US)",
volume = "20",
pages = "202--208",
journal = "Neurocritical Care",
issn = "1541-6933",
publisher = "Humana Press",
number = "2",

}

TY - JOUR

T1 - Association of intraprocedural blood pressure and end tidal carbon dioxide with outcome after acute stroke intervention

AU - Takahashi, Courtney

AU - Brambrink, Ansgar

AU - Aziz, Michael

AU - Macri, Elizabeth

AU - Raines, Joshua

AU - Multani-Kohol, Anmol

AU - Hinson, Holly

AU - Lutsep, Helmi

AU - Clark, Wayne

AU - Fields, Jeremy D.

PY - 2014

Y1 - 2014

N2 - Background: General anesthesia (GA) for acute stroke interventions may be associated with inferior functional outcomes. Our goal was to identify physiologic parameters that mediate this association. Methods: Consecutive patients treated at our institution between August 2007 and December 2010 were identified from a prospective database. Clinical data were then extracted by retrospective chart review. Variables significantly associated with outcome in univariate analysis were also examined in multivariate analysis, controlling for well-established prespecified predictors of functional outcome. Results: Of the 106 patients identified, 20 were excluded (17 due to the absence of 90-day mRS and 3 due to insufficient anesthetic records). Blood pressure (BP) decreased significantly after induction of GA, but there was no association between BP and outcome. End tidal carbon dioxide values (ETCO2) at 60 and 90 min, however, were significantly associated with outcomes in both univariate and multivariate analyses. Mean ETCO2 in patients with favorable outcomes (modified Rankin Scale (mRS) 0-3) was higher than in those with unfavorable outcomes (mRS 4-6): 35.2 mmHg versus 32.2 (p = 0.03) at 60 min and 34.9 versus 31.9 (p = 0.04) at 90 min. The adjusted odds ratios for poor outcomes for each 1 mmHg decrease in ETCO2 were the same: 0.76 (95 % CI 0.65-0.92; p = 0.004) at 60 min and 0.76 (95 % CI 0.61-0.93; p = 0.01) at 90 min. Conclusions: While BP decreased significantly in patients undergoing GA for acute stroke intervention, it did not correlate with patient outcome. Decreases in ETCO2 at 30 and 60 min, however, were associated with 90-day mRS.

AB - Background: General anesthesia (GA) for acute stroke interventions may be associated with inferior functional outcomes. Our goal was to identify physiologic parameters that mediate this association. Methods: Consecutive patients treated at our institution between August 2007 and December 2010 were identified from a prospective database. Clinical data were then extracted by retrospective chart review. Variables significantly associated with outcome in univariate analysis were also examined in multivariate analysis, controlling for well-established prespecified predictors of functional outcome. Results: Of the 106 patients identified, 20 were excluded (17 due to the absence of 90-day mRS and 3 due to insufficient anesthetic records). Blood pressure (BP) decreased significantly after induction of GA, but there was no association between BP and outcome. End tidal carbon dioxide values (ETCO2) at 60 and 90 min, however, were significantly associated with outcomes in both univariate and multivariate analyses. Mean ETCO2 in patients with favorable outcomes (modified Rankin Scale (mRS) 0-3) was higher than in those with unfavorable outcomes (mRS 4-6): 35.2 mmHg versus 32.2 (p = 0.03) at 60 min and 34.9 versus 31.9 (p = 0.04) at 90 min. The adjusted odds ratios for poor outcomes for each 1 mmHg decrease in ETCO2 were the same: 0.76 (95 % CI 0.65-0.92; p = 0.004) at 60 min and 0.76 (95 % CI 0.61-0.93; p = 0.01) at 90 min. Conclusions: While BP decreased significantly in patients undergoing GA for acute stroke intervention, it did not correlate with patient outcome. Decreases in ETCO2 at 30 and 60 min, however, were associated with 90-day mRS.

KW - Anesthesia

KW - Blood pressure

KW - End-tidal carbon dioxide

KW - Endovascular

KW - Stroke

KW - Ventilation

UR - http://www.scopus.com/inward/record.url?scp=84896533041&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896533041&partnerID=8YFLogxK

U2 - 10.1007/s12028-013-9921-3

DO - 10.1007/s12028-013-9921-3

M3 - Article

C2 - 24114519

AN - SCOPUS:84896533041

VL - 20

SP - 202

EP - 208

JO - Neurocritical Care

JF - Neurocritical Care

SN - 1541-6933

IS - 2

ER -