Comparison of Anesthetic Agents Dexmedetomidine and Midazolam During Mechanical Thrombectomy

Michael P. Baldassari, Nikolaos Mouchtouris, Lohit Velagapudi, David Nauheim, Ahmad Sweid, Fadi Al Saiegh, Omaditya Khanna, Ritam Ghosh, Mary Herman, David Wyler, M. Reid Gooch, Stavropoula Tjoumakaris, Pascal Jabbour, Robert Rosenwasser, Victor Romo

Research output: Contribution to journalArticlepeer-review


Objectives: The ideal anesthetic for mechanical thrombectomy (MT) is a subject of debate. Recent studies have supported the use of monitored anesthesia care (MAC), but few have attempted to compare MAC neuroanesthetics. Our study directly compares midazolam and dexmedetomidine (DEX) on blood pressure control during thrombectomy and functional outcomes at discharge. Materials and Methods: We performed a retrospective review of an MT database, which consisted of 612 patients admitted between 2010-2019 to our tertiary stroke center. 193 patients who received either midazolam or DEX for MAC induction were identified. Primary and secondary outcomes were >20% maximum decrease in mean arterial pressure during MT and functional independence respectively. Results: 146 patients were administered midazolam, while 47 were administered DEX. Decrease in blood pressure (BP) during MT was associated with lower rates of functional independence at last follow-up (p=0.034). When compared to midazolam, DEX had significantly higher rates of intraprocedural decrease in MAP at the following cut-offs: >20% (p<0.001), >30% (p=0.001), and >40% (p=0.006). On multivariate analysis, DEX was an independent predictor of >20% MAP decrease (OR 7.042, p<0.001). At time of discharge, NIHSS scores and functional independence (mRS 0-2) were statistically similar between DEX and midazolam. Functional independence at last known follow-up was statistically similar between DEX and midazolam (p = 0.643). Conclusions: Use of DEX during MT appears to be associated with increased blood pressure volatility when compared to midazolam. Further investigation is needed to determine the impact of MAC agents on functional independence.

Original languageEnglish (US)
Article number106117
JournalJournal of Stroke and Cerebrovascular Diseases
Issue number12
StatePublished - Dec 2021
Externally publishedYes


  • Acute stroke
  • Anesthesia
  • Blood pressure
  • Dexmedetomidine
  • Midazolam
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Comparison of Anesthetic Agents Dexmedetomidine and Midazolam During Mechanical Thrombectomy'. Together they form a unique fingerprint.

Cite this