Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke During COVID-19 Pandemic: Consensus Statement From Society for Neuroscience in Anesthesiology & Critical Care (SNACC): Endorsed by Society of Vascular & Interventional Neurology (SVIN), Society of NeuroInterventional Surgery (SNIS), Neurocritical Care Society (NCS), European Society of Minimally Invasive Neurological Therapy (ESMINT) and American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS) Cerebrovascular Section

Abstract

The pandemic of coronavirus disease 2019 (COVID-19) has unique implications for the anesthetic management of endovascular therapy for acute ischemic stroke. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert recommendations using available evidence for the safe and effective anesthetic management of endovascular therapy for acute ischemic stroke during the COVID-19 pandemic. The goal of this consensus statement is to provide recommendations for anesthetic management considering the following (and they are): (1) optimal neurological outcomes for patients; (2) minimizing the risk for health care professionals, and (3) facilitating judicious use of resources while accounting for existing variability in care. It provides a framework for selecting the optimal anesthetic technique (general anesthesia or monitored anesthesia care) for a given patient and offers suggestions for best practices for anesthesia care during the pandemic. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.

FIGURE 1

Flowchart to guide the anesthetic management of patients presenting for EVT of AIS during the pandemic of coronavirus disease 2019. *It is recognized that patients in acute respiratory distress or hypoxemia may require emergent intubation in the ED. Patients suffering from AIS while already in hospital and requiring GA for EVT should be intubated safely in a suitable negative pressure location while minimizing delays in reperfusion. AIS indicates acute ischemic stroke; ED, emergency department; ETT, endotracheal tube; EVT, endovascular therapy; GCS, Glasgow Coma Score; HEPA, high-efficiency particulate air; IR, interventional radiology; SBP, systolic blood pressure; SpO₂, arterial oxygen saturation; NIHSS, National Institutes of Health Stroke Scale/Score.