General anesthesia versus conscious sedation for endovascular therapy in acute ischemic stroke : A systematic review and meta-analysis
Copyright © 2021 Elsevier Ltd. All rights reserved..
BACKGROUND: Endovascular thrombectomy (EVT) is the first-line treatment for patients with acute ischemic stroke (AIS). However, the optimal anesthetic modality during EVT is unclear. Therefore, this systematic review and meta-analysis is aimed to summarize the current literatures from RCTs to provide new clinical evidence of choosing anesthetic modality for AIS patients when receiving EVT.
METHODS: Literature search was conducted in following databases, EMBASE, MEDLINE, Web of Science, and the Cochrane Library, for relevant randomized controlled trials (RCTs) comparing general anesthesia (GA) and conscious sedation (CS) for AIS patients during EVT. We used the Cochrane Collaboration criteria for assessment of risk bias of included studies. The heterogeneity of outcomes was assessed by I2statistic.
RESULTS: 5 RCTs with 498 patients were included. GA was conducted in 251 patients and CS in 247 patients. EVT under GA in AIS patients had higher rates of successful recanalization (RR: 1.13, 95% CI: 1.04-1.23; P = 0.004; I2 = 40.6%) and functional independence at 3 months (RR: 1.28, 95% CI: 1.05-1.55; P = 0.013; I2 = 18.2%) than CS. However, GA was associated with higher risk of mean arterial pressure (MAP) drop (RR: 1.71, 95% CI: 1.19-2.47; P < 0.01; I2 = 80%) and pneumonia (RR: 2.32, 95% CI: 1.23-4.37; P = 0.009; I2 = 33.5%). There was no difference between GA and CS groups in mortality at 3 months, interventional complications, intracerebral hemorrhage and cerebral infarction after 30 days.
CONCLUSIONS: GA was superior over CS in successful recanalization and functional independence at 3 months when performing EVT in AIS patients. However, GA was associated with higher risk of MAP drop and pneumonia. Therefore, results of ongoing RCTs will provide new clinical evidence of anesthetic modality selection during EVT in the future.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:86 |
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| Enthalten in: |
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia - 86(2021) vom: 20. Apr., Seite 10-17 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bai, Xuesong [VerfasserIn] |
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| Links: |
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| Themen: |
Acute ischemic stroke |
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| Anmerkungen: |
Date Completed 31.05.2021 Date Revised 31.05.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jocn.2021.01.012 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM323311601 |
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| 100 | 1 | |a Bai, Xuesong |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a General anesthesia versus conscious sedation for endovascular therapy in acute ischemic stroke |b A systematic review and meta-analysis |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Revised 31.05.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Endovascular thrombectomy (EVT) is the first-line treatment for patients with acute ischemic stroke (AIS). However, the optimal anesthetic modality during EVT is unclear. Therefore, this systematic review and meta-analysis is aimed to summarize the current literatures from RCTs to provide new clinical evidence of choosing anesthetic modality for AIS patients when receiving EVT | ||
| 520 | |a METHODS: Literature search was conducted in following databases, EMBASE, MEDLINE, Web of Science, and the Cochrane Library, for relevant randomized controlled trials (RCTs) comparing general anesthesia (GA) and conscious sedation (CS) for AIS patients during EVT. We used the Cochrane Collaboration criteria for assessment of risk bias of included studies. The heterogeneity of outcomes was assessed by I2statistic | ||
| 520 | |a RESULTS: 5 RCTs with 498 patients were included. GA was conducted in 251 patients and CS in 247 patients. EVT under GA in AIS patients had higher rates of successful recanalization (RR: 1.13, 95% CI: 1.04-1.23; P = 0.004; I2 = 40.6%) and functional independence at 3 months (RR: 1.28, 95% CI: 1.05-1.55; P = 0.013; I2 = 18.2%) than CS. However, GA was associated with higher risk of mean arterial pressure (MAP) drop (RR: 1.71, 95% CI: 1.19-2.47; P < 0.01; I2 = 80%) and pneumonia (RR: 2.32, 95% CI: 1.23-4.37; P = 0.009; I2 = 33.5%). There was no difference between GA and CS groups in mortality at 3 months, interventional complications, intracerebral hemorrhage and cerebral infarction after 30 days | ||
| 520 | |a CONCLUSIONS: GA was superior over CS in successful recanalization and functional independence at 3 months when performing EVT in AIS patients. However, GA was associated with higher risk of MAP drop and pneumonia. Therefore, results of ongoing RCTs will provide new clinical evidence of anesthetic modality selection during EVT in the future | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Acute ischemic stroke | |
| 650 | 4 | |a Conscious sedation | |
| 650 | 4 | |a Endovascular thrombectomy | |
| 650 | 4 | |a General anesthesia | |
| 650 | 4 | |a Meta-analysis | |
| 650 | 4 | |a Systematic review | |
| 700 | 1 | |a Zhang, Xiao |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Tao |e verfasserin |4 aut | |
| 700 | 1 | |a Feng, Yao |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Lyu, Xiajie |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Kun |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Xue |e verfasserin |4 aut | |
| 700 | 1 | |a Song, Haiqing |e verfasserin |4 aut | |
| 700 | 1 | |a Ma, Qingfeng |e verfasserin |4 aut | |
| 700 | 1 | |a Ma, Yan |e verfasserin |4 aut | |
| 700 | 1 | |a Jiao, Liqun |e verfasserin |4 aut | |
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