Type of anaesthesia for acute ischaemic stroke endovascular treatment

Tosello, Renato Tavares; Riera, Rachel; Tosello, Giuliano; Clezar, Caroline Nb; Amorim, Jorge Eduardo de; Vasconcelos, Vladimir; Joao, Benedito B; Flumignan, Ronald Lg

doi:10.1002/14651858.cd013690.pub2

Cited by 12 publications

(14 citation statements)

References 101 publications

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“…Our findings on functional outcome were inconsistent with those of a recent meta-analysis that included seven RCTs (anterior cranial circulation, n = 6; posterior cranial circulation, n = 1) for comparing the impact between GA and non-GA in patients with AIS receiving EVT. While the current study showed a significant association between GA with 3-month functional outcome compared with CS, the recent meta-analysis demonstrated no difference between the GA and non-GA groups (i.e., conscious sedation, local anesthesia, monitored anesthesia care) ( 26 ). The discrepancy in results may be explained by the differences in the number of RCTs included for functional outcome analysis; while the current study extracted relevant information from six RCTs ( 14 – 19 ), the recent meta-analysis only focused on four of our six included studies ( 14 , 15 , 17 , 19 ).…”

Section: Discussioncontrasting

confidence: 56%

“…The discrepancy in results may be explained by the differences in the number of RCTs included for functional outcome analysis; while the current study extracted relevant information from six RCTs ( 14 – 19 ), the recent meta-analysis only focused on four of our six included studies ( 14 , 15 , 17 , 19 ). Further examination of the adequacy of patient sample size of the previous meta-analysis ( 26 ) with TSA indicated no crossing between the z-curve and the RIS (data not shown), suggesting insufficient evidence to reach a sound conclusion for this outcome ( 26 ). In contrast, TSA of the current study demonstrated a satisfactory sample size for reaching a robust conclusion ( Figure 3 ).…”

Section: Discussionmentioning

confidence: 91%

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General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis

et al. 2022

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BackgroundThis study aimed at comparing the difference in prognostic outcomes between patients receiving general anesthesia (GA) and conscious sedation (CS) for endovascular thrombectomy after acute ischemic stroke.MethodsDatabases from Medline, Embase, Google scholar, and Cochrane library were searched for randomized controlled studies (RCTs) comparing patients undergoing GA and CS for endovascular thrombectomy following anterior circulation ischemic stroke. The primary outcome was frequency of 90-day good functional outcome [defined as modified Rankin Scale score of ≤ 2], while secondary outcomes included successful recanalization rate (SRR) [i.e., modified thrombolysis in cerebral infarction = 2b or 3], mortality risk, symptomatic intracranial hemorrhage (ICH), procedure-related complications, hypotension, pneumonia, neurological outcome at post-procedure 24–48 h, and puncture-to-recanalization time.ResultsSix RCTs including 883 patients published between 2016 and 2022 were included. Merged results revealed a higher SRR [risk ratio (RR) = 1.11, 95% CI: 1.03–1.2, p = 0.007; I2 = 29%] and favorable neurological outcomes at 3-months (RR = 1.2, 95% CI: 1.01–1.41, p = 0.04; I2 = 8%) in the GA group compared to CS group, without difference in the risk of mortality (RR = 0.88), symptomatic ICH (RR = 0.91), procedure-related complications (RR = 1.05), and pneumonia (RR = 1.9) as well as post-procedure neurological outcome (MD = −0.21) and successful recanalization time (MD = 3.33 min). However, GA was associated with a higher risk of hypotension compared with that of CS.ConclusionPatients with acute anterior circulation ischemic stroke receiving GA were associated with a higher successful recanalization rate as well as a better 3-month neurological outcome compared to the use of CS. Further investigations are warranted to verify our findings.Systematic review registrationwww.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022342483, identifier: CRD42022342483.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 91%

General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis

et al. 2022

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“…General anaesthesia did not change stroke-related mortality when compared to non-general anaesthesia with low-certainty evidence. In view of the limited evidence of effect, more randomised controlled trials with a large number of participants and good protocol design with a low risk of bias should be performed to reduce the uncertainty and to aid decision-making in the choice of anaesthesia [10].…”

Section: Discussionmentioning

confidence: 99%

Dexmedetomidine infusion in the management of acute ischemic stroke undergoing endovascular recanalization: a retrospective observational study

Pota

Francesco

Crescenzo

et al. 2023

Discov Health Systems

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Background and purpose Stroke is defined as a sudden onset of a neurological deficit caused by an acute focal injury to the central nervous system due to a vascular cause. It represents the second leading cause of death, the third leading cause of disability worldwide and the primary cause of disability in the elderly. Ischemic strokes are the most common (≈85%), the rest (≈15%) are hemorrhagic strokes, that include cerebral and subarachnoid. One of the commonly procedure used in patients with large-vessel occlusion is intra-arterial (IA) recanalization. Moderate conscious sedation (CS) and general anesthesia (GA) with intubation are the most used anesthesia techniques for patients with acute ischemic stroke undergoing endovascular recanalization. Methods In this retrospective observational study, we analyzed data of registry before and after we have changed our sedation protocol from remifentanil/propofol (P/R group) infusion in total intravenous anesthesia (TIVA) to intravenous infusion of dexmedetomidine alone (D group). The primary endpoint was to determine the rate of conversion from CS to GA for each group. The secondary outcomes were the incidence of complications (bradycardia, hypotension, tachycardia, hypertension). Results and conclusion 12 patients in P/R group need the conversion from CS to GA while only 5 patients in D group. There weren't significant differences between the 2 groups respect to heart rate (HR), peripheral oxygen saturation (SpO2) during the procedure, for the good neurological outcome (mRS score < 3, p > .05) and NIHSS score after 48 h (p > .05). There were several organizational and economic advantages with the conscious sedation procedure, such as reduction of occupation time in the operating room and reduction of postoperative Intensive Care Unit (ICU) stay.

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“…In patients with symptomatic chronic subdural hematoma, the use of dexamethasone was investigated in the DEX-CSDH trial, which compared a 2-week tapered course of dexamethasone with a placebo. 5 Dexamethasone resulted in fewer repeat operations but fewer favorable outcomes and more adverse events at 6 months compared with placebo.…”

mentioning

confidence: 90%

“…Decreased movement facilitates clot removal, as demonstrated by the higher rates of reperfusion in motionless patients in the GA arm of multiple MT studies. 5 (3) Prompt and safe conversion from CS to GA if required: Emergent conversion from CS to GA during MT may be required because of patient agitation, respiratory compromise, vomiting, or procedure-related complications such as vascular injury. Conversion from CS to GA is associated with worse neurological outcomes but could not be predicted in the randomized trials.…”

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confidence: 99%

Answering the Call: The Case for Anesthesiologist-led Care for All Stroke Thrombectomies

Whalin

Sharma

2023

Journal of Neurosurgical Anesthesiology

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Type of anaesthesia for acute ischaemic stroke endovascular treatment

Cited by 12 publications

References 101 publications

General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis

General anesthesia but not conscious sedation improves functional outcome in patients receiving endovascular thrombectomy for acute ischemic stroke: A meta-analysis of randomized clinical trials and trial sequence analysis

Dexmedetomidine infusion in the management of acute ischemic stroke undergoing endovascular recanalization: a retrospective observational study

Answering the Call: The Case for Anesthesiologist-led Care for All Stroke Thrombectomies

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