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

Wencai Yang; Feifeng Qiu; Jiancong Chen; Lifang Chen; Min Guan

doi:doi:10.11648/j.ijn.20210501.17

| Peer-Reviewed

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

Wencai Yang, Feifeng Qiu, Jiancong Chen, Lifang Chen, Min Guan

Published in International Journal of Neurosurgery (Volume 5, Issue 1)

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

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

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

[1]	Miao Z R, Huo X C. Endovascular treatment of acute ischemic stroke with large vessel occlusion: history, present and future [J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20 (5): 373-380.
[2]	Kelly D M, Rothwell P M. Prevention and treatment of stroke in patients with chronic kidney disease: an overview of evidence and current guidelines [J]. Kidney International, 2020, 97 (2): 266-278.
[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.
[9]	Lhc A, Yftbc D, Chw E, et al. Validation of two Chinese-version pain observation tools in conscious and unconscious critically ill patients [J]. Intensive and Critical Care Nursing, 2018, 44: 115-122.
[10]	Chookalayia H, Heidarzadeh M, Hassanpour-Darghah M, et al. The Critical care Pain Observation Tool is reliable in non-agitated but not in agitated intubated patients [J]. Intensive and Critical Care Nursing, 2017: 123-128.
[11]	Guan-Hua H E. Applicaton effect of airway open through oropharyngeal airway tube in emergency treatment [J]. Chinese Journal of Clinical Rational Drug Use, 2017, 10 (06): 167-168.
[12]	Aghaebrahim A, Granja M F, Agnoletto G J, et al. Workflow Optimization for Ischemic Stroke in a Community-Based Stroke Center [J]. World Neurosurgery, 2019, 129:e273-e278.
[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.
[18]	Bai X, Zhang X, Wang T, et al. General anesthesia versus conscious sedation for endovascular therapy in acute ischemic stroke: A systematic review and meta-analysis [J]. J Clin Neurosci. 2021, 86: 10-17.
[19]	Pishjoo M, Fazeli F, Hashemi M, et al. General anesthesia versus conscious sedation in mechanical thrombectomy for acute ischemic stroke [J]. Journal of the Neurological Sciences, 2019, 405: 150-151.

Cite This Article

Plain Text BibTeX RIS

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

Copy | Download

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

Copy | Download

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

Copy | Download

@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}
}

Copy | Download

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  -

Copy | Download

Author Information

Wencai Yang

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

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

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

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

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

Download PDF

Sections

Plain Text BibTeX RIS

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

Copy | Download

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

Copy | Download

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

Copy | Download

@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}
}

Copy | Download

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  -

Copy | Download