Association of local anesthesia versus conscious sedation with functional outcome of acute ischemic stroke patients undergoing embolectomy

Abstract

<jats:sec><jats:title>Purpose</jats:title><jats:p> Compare functional outcomes of acute ischemic stroke patients undergoing embolectomy with either local anesthesia or conscious sedation. Secondarily, identify differences in hemodynamic parameters and complication rates between groups. </jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p> Single institution, retrospective review of all acute ischemic stroke patients undergoing embolectomy between January 2014 and July 2018 ( n = 185). Patients receiving general anesthesia ( n = 27) were excluded. One-hundred and eleven of 158 (70.3%) composed the local anesthesia group, and 47 (29.7%) composed the conscious sedation group. Median age was 71 years (interquartile range 59–79). Seventy-eight (49.4%) were male. The median National Institute of Health stroke scale score was 17.5 (interquartile range 11–21). Hemodynamic, medication, complication, and functional outcome data were collected from the anesthesia protocol and medical records. Good functional outcome was defined as a three-month modified Rankin Scale &lt; 2. A multivariate analysis was performed to estimate the association of anesthesia type on three-month modified Rankin Scale score. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Three-month modified Rankin Scale score &lt;2 was similar between groups ( p = 0.5). Patients receiving conscious sedation were on average younger than patients receiving local anesthesia ( p = 0.01). Conscious sedation patients were more likely to receive intravenous thrombolytic prior to embolectomy ( p = 0.025). The complication rate and hemodynamic parameters were similar between groups. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Functional outcome of acute ischemic stroke patients undergoing embolectomy appears to be similar for patients receiving local anesthesia and conscious sedation. This similarity may be beneficial to a future study comparing general anesthesia to local anesthesia and conscious sedation. The use of local anesthesia or conscious sedation does not significantly impact hemodynamic status. </jats:p></jats:sec>

Local anesthesia as a distinct comparator versus conscious sedation and general anesthesia in endovascular stroke treatment: a systematic review and meta-analysis

“…Whilst there is evidence that blood pressure (BP) drops are associated with poor functional outcome due to collateral failure 26,27 ; the neurotoxic or neuroprotective effects of hypnotic agents and optimal intra-and peri-procedural BP targets during the acute ischaemiareperfusion injury are incompletely understood 28 . Of note, in the present analysis, only one of the included studies reported intra-procedural BP measurements and found no statistical differences in their selected haemodynamic parameters 18 .…”

“…Unsurprisingly, due to the logistics of anaesthetic induction and intubation, we found significantly shorter door-to-groin puncture times in the LA group compared to the GA group, which was also shown to favour LA versus CS in the single study reporting on this metric 18 . No statistical difference was identified in groin puncture-to-reperfusion times in the LA vs GA comparison (±SD, minutes) 52.5±31.8 and 56.0±34.5 respectively.…”

“…Whilst these differences were small, we also performed a meta-analysis of extracted adjusted data which revealed similar outcomes. Thirdly, four of the included studies 14,16,18,19 provided data on a per-protocol analysis basis, whilst the rest provided data on the basis of an intention-to-treat analysis, which may have confounded the final outcomes.…”

“…Retrospective data differentiating subjects receiving LA without sedation from CS and GA has recently been published but individual studies have reported conflicting results for the functional outcomes between the LA, CS and GA cohorts [14][15][16][17][18][19][20][21] . Hence, the objective of this systematic and meta-analysis was to assess if LA without sedation resulted in superior procedural and clinical outcomes, compared to CS and GA, in AIS patients following EVT.…”

Analysis of the experience of anesthetic management during endovascular mechanical thrombectomy in ischemic cerebral stroke

“…Немає однозначної думки щодо застосування певних методів анестезії МТЕ. Декілька років тому вважали, що краще проводити МТЕ під загальною анестезією, потім виник інтерес до седації та місцевої анестезії, останніми роками у багатьох джерелах віддають перевагу методу загальної анестезії, аргументом на його користь є віддалені результати МТЕ [5][6][7][8][9][10][11][12].…”