Doug Campbell1, William K Diprose2,3, Carolyn Deng1, P Alan Barber2,3. 1. Departments of Anaesthesia and Perioperative Medicine. 2. Neurology, Auckland City Hospital. 3. Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Abstract
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.
BACKGROUND: In ischemic strokepatients, 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: 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
Authors: Mehmet Enes Inam; Elvira Lekka; Faheem G Sheriff; Aditya A Sanzgiri; Victor Lopez-Rivera; Andrew D Barreto; Sunil A Sheth; Carlos Artime; Allison C Engstrom; Alexander Ambrocik; Claudia Pedroza; Sean I Savitz; Peng Roc Chen Journal: Brain Circ Date: 2021-08-27
Authors: D Michalski; C Jungk; T Brenner; C Nusshag; C J Reuß; M O Fiedler; F C F Schmitt; M Bernhard; C Beynon; M A Weigand; M Dietrich Journal: Anaesthesiologie Date: 2022-09-20