Intubation duration after general anesthesia for thrombectomy in acute ischemic stroke: a cohort study

Objective General anesthesia (GA) is commonly used for acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy. However, the timing of extubation post thrombectomy remains unclear. We aimed to investigate the association of intubation duration and outcomes in these patients. Methods AIS patients receiving acute endovascular thrombectomy under GA were consecutively enrolled. Patients with intubation duration ≥ 96 h and discharged/died with intubation within 96 h were excluded. Adjusted odds ratio (aOR) of intubation duration over the outcomes were obtained. The primary outcome was modified Rankin Scale (mRS) 3–6 at 90 days. Secondary outcomes included pneumonia during hospitalization, 90-day mortality and intracranial hemorrhagic transformation. Results 133 patients were enrolled in final analysis. 69 patients (51.9%) had mRS 3–6 at 90 days. Pneumonia occurred in 74 patients (55.6%). 14 (10.5%) patients died within 90 days follow-up. 31(23.3%) patients experienced intracranial hemorrhagic transformation. In multivariable analysis, longer intubation duration was associated with higher risk of 90-d mRS 3–6 (aOR 1.19 per 6-h increment, 95% CI 1.04–1.35, p = 0.01) and pneumonia (aOR 1.28 per 6-h increment, 95% CI 1.12–1.46, p < 0.001). Conclusion Prolonged intubation duration post-thrombectomy in AIS under GA is associated with increased risk of poor outcome and pneumonia. Intubation duration may serve as a prognostic marker in this setting. But prospective studies are needed to determine whether early extubation improves outcomes.