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Application of Sedation and Analgesia Nursing in Endovascular Treatment of Patients with Acute Ischemic Stroke

Received: 20 February 2021     Accepted: 12 March 2021     Published: 30 April 2021
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Abstract

Background: For acute ischemic stroke (AIS) patients with anterior circulation occlusion, local anesthesia can significantly shorten the time from endovascular treatment to recanalization. Objective: To investigate the application of individualized sedation and analgesia nursing in endovascular treatment (EVT) of patients with anterior-circulation AIS. Methods: From October 2019 to October 2020, all of 78 patients who underwent EVT with anterior-circulation AIS were retrospectively collected. Before interventional preoperative, doctors and nurses cooperated to comprehensively evaluate the patient's condition. Based on fully considering patients' respiratory function, hemodynamic status and pathological and physiological status, individualized sedation and analgesia targets were formulated. The nurses dynamically assessed the patients' sedation score with Sedation-Agitation Scale (SAS) and analgesia score with Critical-Care Pain Observation Tool (CPOT), monitored the depth of sedation and analgesia in real time, adjusted the drug dose, and maintained the ideal sedation and analgesia state of the patients. During the operation, we actively prevented and dealt with the occurrence of adverse reactions such as hypersedation and respiratory depression, and placed oropharyngeal airway to improve ventilation for patients with retroglossal drop and respiratory depression. Results: The SAS score of 78 patients was 5.8±3.7 while entering the operating room. Among them, 71 patients were treated with the midazolam with an average dose of 5.3±2.7 mg, as well as the SAS score of 3.3±1.8 during the operation, and the other 7 patients were cooperated with consciously. Sixty patients were sedated with fentanyl solution at an average dose of 0.38±0.22mg, and the CPOT score was 4.8±3.2 during the operation. The other 18 patients did not use analgesics. The time of Door to Recanalization (D2R) in 78 patients was 50.8±28.6 min. During the operation, there was good cooperation between doctors and nurses, no case of intracranial hemorrhage and no case died. Conclusion: In the EVT of the anterior-circulation AIS patients, medical cooperation developed individualized sedation and analgesia, and the nurses dynamically evaluated the sedation and analgesia score of the patients. By monitoring the depth of sedation and analgesia in real time to adjust the dosage of drugs, patients can maintain in a moderate sedation and analgesia state to ensure the safety of EVT performed.

Published in International Journal of Neurosurgery (Volume 5, Issue 1)
DOI 10.11648/j.ijn.20210501.17
Page(s) 28-32
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

Acute Ischemic Stroke, Endovascular Treatment, Sedation-Agitation Scale, Respiratory Depression, Door to Recanalization Time

References
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[3] Pierot L, Soize S, Benaissa A, et al. Techniques for endovascular treatment of acute ischemic stroke: from intra-arterial fibrinolytics to stent-retrievers [J]. Revue Neurologique, 2015, 46 (3): 909-914.
[4] Ding X, Gu A, Yang Q, et al. Intra-arterial tirofiban in a male nonagenarian with acute ischemic stroke: A case report [J]. Open Life Sciences, 2019, 14 (1): 515-518.
[5] Rui L, Wei L, Erwin S, et al. Endovascular treatment for the acute ischemic stroke: the past and the future [J]. AME Medical Journal, 2018, 3 (15): 1-10.
[6] Powers W J, Rabinstein A A, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [J]. Stroke. 2018; 49 (3): e46-e110.
[7] Peng Y, Wu Y, Huo X, et al. Outcomes of Anesthesia Selection in Endovascular Treatment of Acute Ischemic Stroke. [J]. J Neurosurg Anesthesiol. 2019; 31 (1): 43-49.
[8] Van R D G, Samuels N, Mulder M, et al. Conscious sedation or local anesthesia during endovascular treatment for acute ischemic stroke [J]. Neurology, 2018, 91 (1): e19-e25.
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[13] Groot A E , Bruin H D , Nguyen T , et al. Presentation outside office hours does not negatively influence treatment times for reperfusion therapy for acute ischemic stroke[J]. Journal of Neurology, 2021, 268 (23): 133–139.
[14] Wan T F, Xu R, Zhao Z A, et al. Outcomes of general anesthesia versus conscious sedation for Stroke undergoing endovascular treatment: a meta-analysis [J]. BMC Anesthesiology, 2019, 19: 69.
[15] Anadani M, Audibert G, Gory B. Conscious Sedation versus Local Anesthesia During Thrombectomy for Acute Ischemic Stroke, Do We Have a Winner? – Science Direct [J]. World Neurosurgery, 2021, 146: 383-384.
[16] Howard L W, Demaerschalk B M, Chong B W, et al. Does General Anesthesia Compared With Conscious Sedation Result in Better Outcomes in Acute Stroke Patients Undergoing Endovascular Therapy? [J]. The Neurologist, 2021, 26 (2): 47-51.
[17] Jing R, Dai HJ, Lin F, Ge WY, Pan LH. Conscious Sedation versus General Anesthesia for Patients with Acute Ischemic Stroke Undergoing Endovascular Therapy: A Systematic Review and Meta-Analysis [J]. Biomed Res Int. 2018,(2018-3-29) 2018 (2018): 1-9.
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  • APA Style

    Wencai Yang, Feifeng Qiu, Jiancong Chen, Lifang Chen, Min Guan. (2021). Application of Sedation and Analgesia Nursing in Endovascular Treatment of Patients with Acute Ischemic Stroke. International Journal of Neurosurgery, 5(1), 28-32. https://doi.org/10.11648/j.ijn.20210501.17

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    ACS Style

    Wencai Yang; Feifeng Qiu; Jiancong Chen; Lifang Chen; Min Guan. Application of Sedation and Analgesia Nursing in Endovascular Treatment of Patients with Acute Ischemic Stroke. Int. J. Neurosurg. 2021, 5(1), 28-32. doi: 10.11648/j.ijn.20210501.17

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    AMA Style

    Wencai Yang, Feifeng Qiu, Jiancong Chen, Lifang Chen, Min Guan. Application of Sedation and Analgesia Nursing in Endovascular Treatment of Patients with Acute Ischemic Stroke. Int J Neurosurg. 2021;5(1):28-32. doi: 10.11648/j.ijn.20210501.17

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  • @article{10.11648/j.ijn.20210501.17,
      author = {Wencai Yang and Feifeng Qiu and Jiancong Chen and Lifang Chen and Min Guan},
      title = {Application of Sedation and Analgesia Nursing in Endovascular Treatment of Patients with Acute Ischemic Stroke},
      journal = {International Journal of Neurosurgery},
      volume = {5},
      number = {1},
      pages = {28-32},
      doi = {10.11648/j.ijn.20210501.17},
      url = {https://doi.org/10.11648/j.ijn.20210501.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20210501.17},
      abstract = {Background: For acute ischemic stroke (AIS) patients with anterior circulation occlusion, local anesthesia can significantly shorten the time from endovascular treatment to recanalization. Objective: To investigate the application of individualized sedation and analgesia nursing in endovascular treatment (EVT) of patients with anterior-circulation AIS. Methods: From October 2019 to October 2020, all of 78 patients who underwent EVT with anterior-circulation AIS were retrospectively collected. Before interventional preoperative, doctors and nurses cooperated to comprehensively evaluate the patient's condition. Based on fully considering patients' respiratory function, hemodynamic status and pathological and physiological status, individualized sedation and analgesia targets were formulated. The nurses dynamically assessed the patients' sedation score with Sedation-Agitation Scale (SAS) and analgesia score with Critical-Care Pain Observation Tool (CPOT), monitored the depth of sedation and analgesia in real time, adjusted the drug dose, and maintained the ideal sedation and analgesia state of the patients. During the operation, we actively prevented and dealt with the occurrence of adverse reactions such as hypersedation and respiratory depression, and placed oropharyngeal airway to improve ventilation for patients with retroglossal drop and respiratory depression. Results: The SAS score of 78 patients was 5.8±3.7 while entering the operating room. Among them, 71 patients were treated with the midazolam with an average dose of 5.3±2.7 mg, as well as the SAS score of 3.3±1.8 during the operation, and the other 7 patients were cooperated with consciously. Sixty patients were sedated with fentanyl solution at an average dose of 0.38±0.22mg, and the CPOT score was 4.8±3.2 during the operation. The other 18 patients did not use analgesics. The time of Door to Recanalization (D2R) in 78 patients was 50.8±28.6 min. During the operation, there was good cooperation between doctors and nurses, no case of intracranial hemorrhage and no case died. Conclusion: In the EVT of the anterior-circulation AIS patients, medical cooperation developed individualized sedation and analgesia, and the nurses dynamically evaluated the sedation and analgesia score of the patients. By monitoring the depth of sedation and analgesia in real time to adjust the dosage of drugs, patients can maintain in a moderate sedation and analgesia state to ensure the safety of EVT performed.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - Application of Sedation and Analgesia Nursing in Endovascular Treatment of Patients with Acute Ischemic Stroke
    AU  - Wencai Yang
    AU  - Feifeng Qiu
    AU  - Jiancong Chen
    AU  - Lifang Chen
    AU  - Min Guan
    Y1  - 2021/04/30
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijn.20210501.17
    DO  - 10.11648/j.ijn.20210501.17
    T2  - International Journal of Neurosurgery
    JF  - International Journal of Neurosurgery
    JO  - International Journal of Neurosurgery
    SP  - 28
    EP  - 32
    PB  - Science Publishing Group
    SN  - 2640-1959
    UR  - https://doi.org/10.11648/j.ijn.20210501.17
    AB  - Background: For acute ischemic stroke (AIS) patients with anterior circulation occlusion, local anesthesia can significantly shorten the time from endovascular treatment to recanalization. Objective: To investigate the application of individualized sedation and analgesia nursing in endovascular treatment (EVT) of patients with anterior-circulation AIS. Methods: From October 2019 to October 2020, all of 78 patients who underwent EVT with anterior-circulation AIS were retrospectively collected. Before interventional preoperative, doctors and nurses cooperated to comprehensively evaluate the patient's condition. Based on fully considering patients' respiratory function, hemodynamic status and pathological and physiological status, individualized sedation and analgesia targets were formulated. The nurses dynamically assessed the patients' sedation score with Sedation-Agitation Scale (SAS) and analgesia score with Critical-Care Pain Observation Tool (CPOT), monitored the depth of sedation and analgesia in real time, adjusted the drug dose, and maintained the ideal sedation and analgesia state of the patients. During the operation, we actively prevented and dealt with the occurrence of adverse reactions such as hypersedation and respiratory depression, and placed oropharyngeal airway to improve ventilation for patients with retroglossal drop and respiratory depression. Results: The SAS score of 78 patients was 5.8±3.7 while entering the operating room. Among them, 71 patients were treated with the midazolam with an average dose of 5.3±2.7 mg, as well as the SAS score of 3.3±1.8 during the operation, and the other 7 patients were cooperated with consciously. Sixty patients were sedated with fentanyl solution at an average dose of 0.38±0.22mg, and the CPOT score was 4.8±3.2 during the operation. The other 18 patients did not use analgesics. The time of Door to Recanalization (D2R) in 78 patients was 50.8±28.6 min. During the operation, there was good cooperation between doctors and nurses, no case of intracranial hemorrhage and no case died. Conclusion: In the EVT of the anterior-circulation AIS patients, medical cooperation developed individualized sedation and analgesia, and the nurses dynamically evaluated the sedation and analgesia score of the patients. By monitoring the depth of sedation and analgesia in real time to adjust the dosage of drugs, patients can maintain in a moderate sedation and analgesia state to ensure the safety of EVT performed.
    VL  - 5
    IS  - 1
    ER  - 

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Author Information
  • Interventional Operating Room, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Interventional Operating Room, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Interventional Operating Room, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Interventional Operating Room, The First Affiliated Hospital of Jinan University, Guangzhou, China

  • Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China

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