General Anesthesia versus Conscious Sedation in Mechanical Thrombectomy.

Autor:	Feil K; Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany.; Department of Neurology & Stroke, Eberhard-Karls University of Tübingen, Tübingen, Germany., Herzberg M; Institute of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany.; Department of Radiology, University Hospital Würzburg, Würzburg, Germany., Dorn F; Institute of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany., Tiedt S; Institute for Stroke and Dementia Research, Ludwig Maximilian University (LMU), Munich, Germany., Küpper C; Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany., Thunstedt DC; Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany., Hinske LC; Department of Anesthesiology, Ludwig Maximilian University (LMU), Munich, Germany.; The Institute for Medical Information Biometry and Epidemiology (IBE), Ludwig Maximilian University (LMU), Munich, Germany., Mühlbauer K; Department of Anesthesiology, Ludwig Maximilian University (LMU), Munich, Germany., Goss S; Department of Anesthesiology, Ludwig Maximilian University (LMU), Munich, Germany., Liebig T; Institute of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany., Dieterich M; Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.; German Center for Vertigo and Balance Disorders, Ludwig Maximilian University (LMU), Munich, Germany., Bayer A; Department of Anesthesiology, Ludwig Maximilian University (LMU), Munich, Germany., Kellert L; Department of Neurology, Ludwig Maximilian University (LMU), Munich, Germany.
Jazyk:	angličtina
Zdroj:	Journal of stroke [J Stroke] 2021 Jan; Vol. 23 (1), pp. 103-112. Date of Electronic Publication: 2021 Jan 31.
DOI:	10.5853/jos.2020.02404
Abstrakt:	Background and Purpose: Anesthesia regimen in patients undergoing mechanical thrombectomy (MT) is still an unresolved issue. Methods: We compared the effect of anesthesia regimen using data from the German Stroke Registry-Endovascular Treatment (GSR-ET) between June 2015 and December 2019. Degree of disability was rated by the modified Rankin Scale (mRS), and good outcome was defined as mRS 0-2. Successful reperfusion was assumed when the modified thrombolysis in cerebral infarction scale was 2b-3. Results: Out of 6,635 patients, 67.1% (n=4,453) patients underwent general anesthesia (GA), 24.9% (n=1,650) conscious sedation (CS), and 3.3% (n=219) conversion from CS to GA. Rate of successful reperfusion was similar across all three groups (83.0% vs. 84.2% vs. 82.6%, P=0.149). Compared to the CA-group, the GA-group had a delay from admission to groin (71.0 minutes vs. 61.0 minutes, P<0.001), but a comparable interval from groin to flow restoration (41.0 minutes vs. 39.0 minutes). The CS-group had the lowest rate of periprocedural complications (15.0% vs. 21.0% vs. 28.3%, P<0.001). The CS-group was more likely to have a good outcome at follow-up (42.1% vs. 34.2% vs. 33.5%, P<0.001) and a lower mortality rate (23.4% vs. 34.2% vs. 26.0%, P<0.001). In multivariable analysis, GA was associated with reduced achievement of good functional outcome (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71 to 0.94; P=0.004) and increased mortality (OR, 1.42; 95% CI, 1.23 to 1.64; P<0.001). Subgroup analysis for anterior circulation strokes (n=5,808) showed comparable results. Conclusions: We provide further evidence that CS during MT has advantages over GA in terms of complications, time intervals, and functional outcome.
Databáze:	MEDLINE
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