Jian Sun1,2, Fa Liang1, Youxuan Wu1, Yan Zhao1, Zhongrong Miao3, Li Zhang4, Adrian W Gelb5, Matthew T V Chan6, Yuming Peng1, Ruquan Han1. 1. Departments of Anesthesiology. 2. Department of Anesthesiology, Beijing Fuxing Hospital, Capital Medical University, Beijing. 3. Interventional Neurology, Beijing Tiantan Hospital. 4. Division of Hematology and Medical Oncology, Department of Medicine, Department of Epidemiology and Biostatistics. 5. Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco, CA. 6. Department of Anaesthesia and Intensive Care, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong Special Administrative Region, PR China.
Abstract
BACKGROUND: The effect of choice of anesthesia on clinical outcome for endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) remains unclear. METHODS: We conducted a pilot trial of 43 patients with acute anterior circulation ischemic stroke having EVT. Patients were randomly allocated to receive general anesthesia or conscious sedation. We documented the rate of recruitment and rate of conversion from conscious sedation to general anesthesia. In addition, we recorded the change in National Institute of Health stroke scale (NIHSS) on day 7, the rate of successful reperfusion and measured neurological function by certified researchers using modified Rankin Score (mRS 0 to 2) at 90 days. RESULTS: The recruitment rate was 31.4% and majority of patients were excluded because of delay in hospital presentation and posterior circulation stroke. The rate of conversion from conscious sedation to general anesthesia was 18.2%. This was primarily related to excessive sedation and uncontrolled movement. Change in NIHSS score, rate of successful reperfusion and functional recovery were similar between groups. CONCLUSIONS: It was feasible to randomize AIS patients receiving either general anesthesia or conscious sedation for EVT.
BACKGROUND: The effect of choice of anesthesia on clinical outcome for endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) remains unclear. METHODS: We conducted a pilot trial of 43 patients with acute anterior circulation ischemic stroke having EVT. Patients were randomly allocated to receive general anesthesia or conscious sedation. We documented the rate of recruitment and rate of conversion from conscious sedation to general anesthesia. In addition, we recorded the change in National Institute of Health stroke scale (NIHSS) on day 7, the rate of successful reperfusion and measured neurological function by certified researchers using modified Rankin Score (mRS 0 to 2) at 90 days. RESULTS: The recruitment rate was 31.4% and majority of patients were excluded because of delay in hospital presentation and posterior circulation stroke. The rate of conversion from conscious sedation to general anesthesia was 18.2%. This was primarily related to excessive sedation and uncontrolled movement. Change in NIHSS score, rate of successful reperfusion and functional recovery were similar between groups. CONCLUSIONS: It was feasible to randomize AIS patients receiving either general anesthesia or conscious sedation for EVT.
Authors: Renato Tosello; Rachel Riera; Giuliano Tosello; Caroline Nb Clezar; Jorge E Amorim; Vladimir Vasconcelos; Benedito B Joao; Ronald Lg Flumignan Journal: Cochrane Database Syst Rev Date: 2022-07-20