Anesthesia for acute stroke

There are many factors that can affect anesthetic management and consequent outcomes for mechanical thrombectomy in patients with acute ischemic stroke. In this chapter, we review evidence for neuroprotection by specific anesthetic agents and examine the controversy between use of general anesthesia vs. conscious sedation for patients undergoing mechanical thrombectomy. We contrast the retrospective data suggesting an association between general anesthesia and worse patient outcome, with three salient randomized control studies supporting that modality does not impact patient outcome as long as adequate perfusion is maintained. We conclude the chapter with a summary of current expert consensus regarding preprocedural assessment, intraprocedural physiologic parameters, and postoperative care surrounding patients undergoing mechanical thrombectomy.