Adverse events with monitored anesthesia care sedation in patients with stroke receiving mechanical thrombectomy.

BACKGROUND: Monitored anesthesia care (MAC) sedation for mechanical thrombectomy in stroke patients is considered safe. The association of MAC sedation with respiratory complications is not well studied. OBJECTIVE: To evaluate adverse events among patients who receive MAC sedation for treatment of acute stroke with thrombectomy. METHODS: A retrospective review of adverse events at a single institution between 2020 and 2024 was performed. Univariate and multivariable logistic regression identified clinical covariates associated with the likelihood of adverse outcomes. RESULTS: Among 348 patients treated for stroke with MAC, 310 had no adverse events. Univariate analysis showed patients aged 60-69 years were 3.23 times more likely to have an adverse event than patients <60 years old and >8 times more likely to develop acute respiratory failure. Multivariable analysis indicated smokers were 2.4 times more likely to have an adverse event (odds ratio [OR], 2.41; 95% CI, 1.01-5.72; p = 0.046). Patients aged 60-69 were >3 times as likely to require prolonged ventilation (OR, 3.75; 95% CI, 1.12-12.6; p = 0.03). Patients with comorbidities were also >3 times as likely to require prolonged ventilation (OR, 3.45; 95% CI, 1.49-7.95; p = 0.004). Age, sex, race, body mass index, stroke location, and stroke history were not associated with adverse events, ventilator use, or acute respiratory failure. CONCLUSION: MAC is a safe method for stroke patients undergoing thrombectomy. Smoking, age 60-69 years, and some comorbidities increased odds of respiratory adverse events, underscoring the importance of preoperative risk stratification.