• World Neurosurg · Jan 2024

    Review Meta Analysis

    General anesthesia versus conscious sedation for acute ischemic stroke endovascular therapy: A Meta Analysis of Randomized Controlled Trials.

    • Mohammed Maan Al-Salihi, Ram Saha, Ali Ayyad, Maryam Sabah Al-Jebur, Yezan Al-Salihi, Anil Roy, Shamser Singh Dalal, and Adnan I Qureshi.
    • Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA. Electronic address: mohammed.wwt@gmail.com.
    • World Neurosurg. 2024 Jan 1; 181: 161170.e2161-170.e2.

    BackgroundEndovascular thrombectomy (E.V.T.) is the primary treatment for acute ischemic stroke (AIS). Nevertheless, the optimal choice of anesthetic modality during E.V.T. remains uncertain. This systematic review and meta-analysis aim to summarize existing literature from randomized controlled trials (RCTs) to guide the selection of the most appropriate anesthetic modality for AIS patients undergoing E.V.T.MethodsBy a thorough search strategy, RCTs comparing general anesthesia (G.A.) and conscious sedation (C.S.) in E.V.T. for AIS patients were identified. Eligible studies were independently screened, and relevant data were extracted. The analysis employed pooled risk ratio for dichotomous outcomes and the mean difference for continuous ones. RCTs quality was assessed using the Cochrane Risk of Bias assessment tool 1.ResultsIn the functional independence outcome (mRS scores 0-2), the pooled analysis did not favor either G.A. or C.S. arms, with an RR of 1.10 [0.95, 1.27] (P = 0.19). Excellent (mRS 0-1) and poor (≥3) recovery outcomes did not significantly differ between G.A. and C.S. groups, with RR values of 1.03 [0.80, 1.33] (P = 0.82) and 0.93 [0.84, 1.03] (P = 0.16), respectively. Successful recanalization significantly favored G.A. over C.S. (RR 1.13 [1.07, 1.20], P > 0.001).ConclusionsG.A. had superior recanalization rates in AIS patients undergoing endovascular therapy, but functional outcomes, mortality, and NIHSS scores were similar. Secondary outcomes showed no significant differences, except for a higher risk of hypotension with G.A. More trials are required to determine the optimal anesthesia approach for thrombectomy in AIS patients.Copyright © 2023 Elsevier Inc. All rights reserved.

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