Protocol-based general anesthesia was linked to less disability at 3 months compared with procedural sedation among patients with acute ischemic stroke in the anterior circulation who underwent thrombectomy, according to a systematic review and meta-analysis published in JAMA.
“These findings should be interpreted tentatively because the individual trials analyzed were single-center trials and disability was the primary outcome in only one trial,” Silvia Schönenberger, MD, medical director of the neurological intensive care unit and senior physician at Heidelberg University Hospital in Germany, and colleagues wrote.
Researchers analyzed data from 368 patients (mean age, 72 years; 44% women) from three trials published from 1980 to July 2019. Patients in these trials were adults with a NIH Stroke Scale score of at least 10 and had an acute ischemic stroke in the anterior circulation. These patients were assigned general anesthesia (n = 183) or procedural sedation (n = 185) during thrombectomy.
The primary outcome was the degree of disability at 3 months, which was measured by a modified Rankin Scale score.
At 3 months, the mean modified Rankin Scale score was 2.8 in patients assigned general anesthesia (95% CI, 2.5-3.1) and 3.2 in those assigned procedural sedation (95% CI, 3-3.5; difference = 0.43; 95% CI, 0.03-0.83). There were significantly different results in the main analysis of the primary outcome that favored general anesthesia vs. procedural sedation (common OR = 1.58; 95% CI, 1.09-2.29).
Adverse events that were significantly more common among patients assigned general anesthesia compared with those assigned procedural sedation included BP variability (79.7% vs. 62.3%; OR = 2.42; 95% CI, 1.49-3.93) and hypotension (80.8% vs. 53.1%; OR = 4.26; 95% CI, 2.55-7.09).
“Further research is needed to identify clinical and radiologic factors that could predict when primary general anesthesia is necessary to reduce the number of emergency conversions from procedural sedation to general anesthesia,” Schönenberger and colleagues wrote. “Given the likelihood that the patient population and anesthetic strategies investigated in this analysis differ from those in other countries, a large, multicenter randomized controlled trial including at least a basic agreement on standards of procedure and physiology parameter targets directed at functional outcome after 3 months is necessary.” – by Darlene Dobkowski
Disclosures: Schönenberger reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.