Journal
JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY
Volume 33, Issue 1, Pages 21-27Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/ANA.0000000000000646
Keywords
ischemic stroke; general anesthesia; conscious sedation; endovascular thrombectomy
Categories
Funding
- Neurological Foundation of New Zealand
- Julius Brendel Trust
Ask authors/readers for more resources
Randomized controlled trials comparing general anesthesia (GA) to conscious sedation (CS) in endovascular thrombectomy patients showed that GA patients achieved higher successful recanalization and good functional outcomes, with no significant differences in intracerebral hemorrhage and 3-month mortality compared to CS patients.
Background: In ischemic stroke patients, studies have suggested that clinical outcomes following endovascular thrombectomy are worse after general anesthesia (GA) compared with conscious sedation (CS). Most data are from observational trials, which are prone to measure and unmeasure confounding. We performed a systematic review and meta-analysis of thrombectomy trials where patients were randomized to GA or CS, and compared efficacy and safety outcomes. Methods: The Medline, Embase, and Cochrane databases were searched for randomized controlled trials comparing GA to CS in endovascular thrombectomy. Efficacy outcomes included successful recanalization (Thrombolysis in Cerebral Infarction score of 2b to 3), and good functional outcome, defined as a modified Rankin Scale score of 0 to 2 at 3 months. Safety outcomes included intracerebral hemorrhage and 3-month mortality. Results: Four studies were identified and included in the random effects meta-analysis. Patients treated with GA achieved a higher proportion of successful recanalization (odds ratio [OR]: 2.14, 95% confidence interval [CI]: 1.26-3.62; P=0.005) and good functional outcome (OR: 1.71, 95% CI: 1.13-2.59; P=0.01). For every 7.9 patients receiving GA, one more achieved good functional outcome compared with those receiving CS. There were no significant differences in intracerebral hemorrhage (OR: 0.61, 95% CI: 0.20-1.85; P=0.38) or 3-month mortality (OR: 0.62, 95% CI: 0.33-1.17; P=0.14) between GA and CS patients. Conclusions: In centers with high quality, specialized neuroanesthesia care, GA treated thrombectomy patients had superior recanalization rates and better functional outcome at 3 months than patients receiving CS.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available