Both GA and conscious sedation reasonable anaesthetic approaches for patients undergoing endovascular thrombectomy
Endovascular thrombectomy (EVT) is established as the standard treatment for managing patients with acute ischemic stroke (AIS) patients with large vessel occlusion (LVO). However, the ideal anesthetic approach during EVT remains undetermined.
A study published in the International Journal of Stroke concluded that the choice of anesthetic modality for AIS patients undergoing EVT did not seem to impact their 3-month neurological outcomes. However, regarding successful reperfusion rates, GA was superior to CS. Additionally, patients in the GA group were at a higher risk for developing hypotension and pneumonia. More research is needed to provide additional evidence.
This systematic review and meta-analysis determined the optimal anesthetic modality for AIS patients undergoing EVT by examining current randomized controlled trials (RCTs).
Researchers evaluated databases Medline (via PubMed), EMBASE, Web of Science, and the Cochrane Library for RCTs comparing general anesthesia (GA) and conscious sedation (CS) in AIS patients undergoing EVT. The primary outcome was a favourable functional outcome at 90 days post-intervention. Review Manager software (RevMan V.5.3) was used for data analysis.
Key findings from the study are:
• Eight RCTs with 1199 patients were included.
• There was no significant difference between these two groups in the rate of functional independence with a risk ratio of 1.10
• Compared with the CS group, the GA group attained a higher successful recanalization rate with an RR of 1.14
• Patients in the GA had higher rates of hypotension and pneumonia incidence with RR of 1.87 and 1.38, respectively.
They said, ‘This systematic review and meta-analysis examined the clinical outcomes of conscious sedation versus general anesthesia during endovascular thrombectomy. Pooling data from eight randomized clinical trials, most of which were single-centre and European studies, the study found no significant difference in 3-month functional outcomes between the two groups. However, the general anaesthesia group had a higher rate of successful reperfusion but also higher rates of periprocedural hypertension and pneumonia. The meta-analysis suggests that both conscious sedation and general anesthesia are reasonable options for patients undergoing endovascular thrombectomy. Centre experience and patient characteristics are also important factors in decision-making.’
Reference:
Jia Y, Feng Y, Ma Y, et al. Type of anaesthesia for endovascular therapy in acute ischemic stroke: A literature review and meta-analysis. International Journal of Stroke. 2024;0(0).
doi:10.1177/17474930241228956
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