Free
Correspondence  |   September 2012
The Time When Hypotension Occurs May Be Important in the Management of Intraarterial Thrombolysis for Stroke
Author Affiliations & Notes
  • Adrian W. Gelb, M.B.Ch.B., F.R.C.P.C.
    *
  • *University of California, San Francisco, San Francisco, California.
Article Information
Correspondence
Correspondence   |   September 2012
The Time When Hypotension Occurs May Be Important in the Management of Intraarterial Thrombolysis for Stroke
Anesthesiology 9 2012, Vol.117, 683-684. doi:10.1097/ALN.0b013e3182625692
Anesthesiology 9 2012, Vol.117, 683-684. doi:10.1097/ALN.0b013e3182625692
To the Editor: 
The contributions of general anesthesia and blood pressure management, either independently or together, to adverse outcome from intraarterial thrombolysis for stroke may be important. Davis et al.  have attempted to study this through a retrospective analysis of their patient experience.1 They concluded “that patients managed with general anesthesia, and its concomitant relative systolic hypotension, during endovascular therapy for acute ischemic stroke have a much lower likelihood of good neurologic outcome, compared to patients managed with local anesthesia.” We note, however, that the lowest average systolic blood pressure in the general anesthesia group, 104 ± 17 mmHg, is exactly the same as the baseline systolic blood pressure. Baseline measurements are usually those made at some time-point before the initiation of general anesthesia, e.g.  , in the emergency department, the preoperative area, or the first blood pressure on arrival in the operating room.
We don't dispute the potential detrimental effect of low blood pressure, but if the lowest blood pressure was indeed the baseline value, i.e.  , before anesthesia, then the conclusion needs to focus not just on intraprocedural blood pressure but on the contributions of hypotension from the onset of the stroke, emergency medical services care, and management in the emergency department. These may be longer periods of hypotension than the actual procedure.
Reference
1. Davis MJ, Menon BK, Baghirzada LB, Campos-Herrera CR, Goyal M, Hill MD, Archer DP, Calgary Stroke Program: Anesthetic management and outcome in patients during endovascular therapy for acute stroke. ANESTHESIOLOGY 2012; 116:396–405
1. Davis MJ, Menon BK, Baghirzada LB, Campos-Herrera CR, Goyal M, Hill MD, Archer DP, Calgary Stroke Program: Anesthetic management and outcome in patients during endovascular therapy for acute stroke. ANESTHESIOLOGY 2012; 116:396–405×