Open AccessMonitored anesthesia care for the acute ischemic stroke patient with end-stage pulmonary disease
Author(s) -
Kevin C. Lee,
Brian C. Lee,
Steven E. Miller
Publication year - 2017
Publication title -
al-banǧ. maqālāt wa abḥāṯ fī al-taẖdīr wa-al-in’āš
Language(s) - English
Resource type - Journals
ISSN - 0259-1162
DOI - 10.4103/aer.aer_95_17
Subject(s) - medicine , extracorporeal membrane oxygenation , recombinant tissue plasminogen activator , anesthesia , stroke (engine) , anesthetic , tissue plasminogen activator , surgery , ischemic stroke , ischemia , cardiology , mechanical engineering , modified rankin scale , engineering
The majority of patients who suffer acute ischemic stroke (AIS) from large vessel occlusion are at a significant risk for disability or death. Because patients on veno-arterial extracorporeal membrane oxygenation (VA ECMO) are therapeutically anticoagulated, intravenous recombinant tissue plasminogen activator is contraindicated. For AIS management, these patients must undergo emergent intra-arterial therapy. Presented is a patient on VA ECMO who subsequently suffered a large vessel embolic stroke requiring emergent surgical intervention. The decision by our anesthetic team to perform the procedure under monitored anesthesia care is discussed.