Abstract WP3: The Use Of Monitored Anesthesia Care In Place Of Nurse Administered Conscious Sedation Does Not Result In Delays To Emergent Thrombectomy.

Introduction: There has been considerable emphasis on the use of monitored anesthesia care (MAC) versus general anesthesia for emergent mechanical thrombectomy (EMT). However, due to concerns over potential delays many centers do not involve anesthesia services but instead rely on nurse administered conscious sedation (NACS). Since our center switched from NACS to MAC in 2020, we decided to investigate the impact of this switch on our thrombectomy procedures. Methods: Using a prospectively maintained Comprehensive Stroke Center quality improvement database, we reviewed our hospital EMT cases from June 2018 to April 2020 (pre-anesthesia involvement, NACS only) and May 2020 to March 2022 (post-anesthesia involvement). Main inclusion criteria were evidence of a proximal LVO and emergent transport for EMT. Variables reviewed included, time to arterial access from neurointerventional suite arrival, time to first pass, and time to TICI 2b/3. Median outcomes were compared using Mann-Whitney U test. Results: From June 2018 through April 2020 there were a total of 146 LVO cases that received EVT, compared to a total of 209 LVO cases receiving EVT from May 2020 to March 2022. The median time to arterial access from arrival in the neurointerventional suite was significantly longer before anesthesia involvement (June 2018 to April 2020, 16 minutes) compared to the period after anesthesia involvement (May 2020 to March 2022, 10 minutes) (p < 0.0001). There was no significant difference in median time to first pass between the pre-anesthesia (25 minutes) versus post-anesthesia (26 minutes) time frame (p = 0.43). Median time to TICI 2b/3 was faster post-anesthesia (35 minutes) versus pre-anesthesia (40 minutes) involvement (p = 0.19). Conclusion: Our data suggests faster arterial access for EMT and no significant increase in time to first pass or final recanalization after starting to use anesthesia services. The reasons for this are likely multifactorial but may include the offloading of operator responsibilities for managing sedation, blood pressure, and airway security in these often critically ill LVO stroke patients.