Anesthesia for Acute Ischemic Stroke: Updates and Ongoing Debates

Purpose of Review Advancements in stroke therapeutics and endovascular therapy in the last decade have dramatically changed the management of acute ischemic stroke, the structure of stroke care pathways, and demand for anesthesia resources. This review outlines the evolving perspectives on anesthetic management for the thrombectomy patient, including areas of debate, current recommendations, and future directions for research. Recent Findings Key concepts in stroke care include immediate medical attention, emergent transfer to a stroke facility, physiologic and hemodynamic stabilization, and rapid recanalization. Although optimal anesthetic technique is contested, there are evidence-based recommendations regarding physiologic and hemodynamic management on which the anesthesiologist can base their practice. Summary As anesthesiologists become more engaged in stroke care, lessons from this area can be used to understand other important questions of relevance to anesthesia. By investigating neurological outcomes related to physiologic management and anesthetic exposure, we can gain important information that can be applied to an aging population of perioperative patients.