Evidence map›Paper›PMID 26787251›Full record

Trial reportBMJ open2016

Rigorous anaesthesia management protocol for patients with intracranial arterial stenosis: a prospective controlled-cohort study.

Azim N Laiwalla, Yinn Cher Ooi, Barbara Van De Wiele, Keren Ziv, Adam Brown, Raymond Liou, Jeffrey L Saver, Nestor R Gonzalez

Registry-linked trialAbstract readClinical Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01819597 (EDAS), which is not on this map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01819597 nacompletednot on this map

EDAS (Surgical) Revascularization for Symptomatic Intracranial Arterial Stenosis

TypeinterventionalSponsorCedars-Sinai Medical CenterRan2013 to 2018Enrolled52ConditionsIntracranial Arterial Stenosis, Intracranial Atherosclerosis, Ischemic Stroke, Cerebral AngiogenesisArmsEncephaloduroarteriosynangiosis (EDAS)
3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Trial
  2. The effect of procedural end-tidal CO2 on infarct expansion during anterior circulation thrombectomy.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2024
    Article
  3. Article
  4. Article
  5. Differential Expression of Vascular Endothelial Growth Factor-AJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2019
    Article
  6. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Azim N LaiwallaDepartment of Neurosurgery, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, USA.
Yinn Cher OoiDepartment of Neurosurgery, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, USA.
Barbara Van De WieleDepartment of Anesthesiology, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, USA.
Keren ZivDepartment of Anesthesiology, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, USA.
Adam BrownDepartment of Anesthesiology, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, USA.
Raymond LiouDepartment of Neurosurgery, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, USA.
Jeffrey L SaverDepartment of Neurology, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, USA.
Nestor R GonzalezDepartment of Neurosurgery and Radiology, David Geffen School of Medicine at the University of California (UCLA), Los Angeles, California, USA.

Funding

Surgical Indirect Revascularization For Symptomatic Intracranial Aterial StenosisK23NS079477 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI GONZALEZ, NESTOR RAUL · 2013 to 2017
$842k
NINDS NIH HHS K23 NS079477NINDS NIH HHS K23NS079477
6 · The paper itself

Abstract

objectivesReducing variability is integral in quality management. As part of the ongoing Encephaloduroarteriosynangiosis Revascularisation for Symptomatic Intracranial Arterial Stenosis (ERSIAS) trial, we developed a strict anaesthesia protocol to minimise fluctuations in patient parameters affecting cerebral perfusion. We hypothesise that this protocol reduces the intraoperative variability of targeted monitored parameters compared to standard management.

designProspective cohort study of patients undergoing encephaloduroarteriosynangiosis surgery versus standard neurovascular interventions. Patients with ERSIAS had strict perioperative management that included normocapnia and intentional hypertension. Control patients received regular anaesthetic standard of care. Minute-by-minute intraoperative vitals were electronically collected. Heterogeneity of variance tests were used to compare variance across groups. Mixed-model regression analysis was performed to establish the effects of treatment group on the monitored parameters.

settingTertiary care centre.

participants24 participants: 12 cases (53.8 years ± 16.7 years; 10 females) and 12 controls (51.3 years ± 15.2 years; 10 females). Adults aged 30-80 years, with transient ischaemic attack or non-disabling stroke (modified Rankin Scale <3) attributed to 70-99% intracranial stenosis of the carotid or middle cerebral artery, were considered for enrolment. Controls were matched according to age, gender and history of neurovascular intervention.

main outcome measuresVariability of heart rate, mean arterial blood pressure (MAP), systolic blood pressure and end tidal CO2 (ETCO2) throughout surgical duration.

resultsThere were significant reductions in the intraoperative MAP SD (4.26 vs 10.23 mm Hg; p=0.007) and ETCO2 SD (0.94 vs 1.26 mm Hg; p=0.05) between the ERSIAS and control groups. Median MAP and ETCO2 in the ERSIAS group were higher (98 mm Hg, IQR 23 vs 75 mm Hg, IQR 15; p<0.001, and 38 mm Hg, IQR 4 vs 32 mm Hg, IQR 3; p<0.001, respectively).

conclusionsThe ERSIAS anaesthesia protocol successfully reduced intraoperative fluctuations of MAP and ETCO2. The protocol also achieved normocarbia and the intended hypertension. TRIAL REGISTRATION NUMBER: NCT01819597; Pre-results.

Indexed as

AdultAgedAged, 80 and overAnesthesiaCarotid StenosisCase-Control StudiesClinical ProtocolsFemaleHumansInfarction, Middle Cerebral ArteryMaleMiddle AgedModels, StatisticalMonitoring, IntraoperativeOutcome and Process Assessment, Health CareProspective StudiesNEUROSURGERYSTROKE MEDICINE

Identifiers

PMID26787251
PMCPMC4735305

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.