General anesthesia versus conscious sedation in mechanical thrombectomy for patients with acute ischemic stroke: systematic review and meta-analysis.
| Autor: | Santos ACFF; Universidad Privada Franz Tamayo, Facultad de Ciencias de la Salud, La Paz, Bolivia., Coelho LLS; UDI Hospital Rede D'Or São Luiz, São Luís MA, Brazil., Caldas GC; Neurosurgical Innovations and Training Center, WCMC, New York, New York, United States., Araújo LC; Ebserh, Universidade Federal de Pernambuco, Hospital das Clínicas,, Recife PE, Brazil., Gagliardi VDB; Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil., Carbonera LA; Hospital Moinhos de Vento, Serviço de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil. |
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| Jazyk: | angličtina |
| Zdroj: | Arquivos de neuro-psiquiatria [Arq Neuropsiquiatr] 2024 Apr; Vol. 82 (4), pp. 1-7. Date of Electronic Publication: 2024 Apr 12. |
| DOI: | 10.1055/s-0044-1785693 |
| Abstrakt: | Background: After recently published randomized clinical trials, the choice of the best anesthetic procedure for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) is not definite. Objective: To compare the efficacy and safety of general anesthesia (GA) versus conscious sedation (CS) in patients with AIS who underwent MT, explicitly focusing on procedural and clinical outcomes and the incidence of adverse events. Methods: PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials (RCTs) comparing GA versus CS in patients who underwent MT due to LVO-AIS. Odds ratios (ORs) were calculated for binary outcomes, with 95% confidence intervals (CIs). Random effects models were used for all outcomes. Heterogeneity was assessed with I2 statistics. Results: Eight RCTs (1,300 patients) were included, of whom 650 (50%) underwent GA. Recanalization success was significantly higher in the GA group (OR 1.68; 95% CI 1.26-2.24; p < 0.04) than in CS. No significant difference between groups were found for good functional recovery (OR 1.13; IC 95% 0.76-1.67; p = 0.56), incidence of pneumonia (OR 1.23; IC 95% 0.56- 2,69; p = 0.61), three-month mortality (OR 0.99; IC 95% 0.73-1.34; p = 0.95), or cerebral hemorrhage (OR 0.97; IC 95% 0.68-1.38; p = 0.88). Conclusion: Despite the increase in recanalization success rates in the GA group, GA and CS show similar rates of good functional recovery, three-month mortality, incidence of pneumonia, and cerebral hemorrhage in patients undergoing MT. Competing Interests: LAC reports receiving a restricted grant from the World Stroke Organization for this work and consulting and speaker fees from Allm, AstraZeneca, Boehringer Ingelheim, and ISchemaView, outside of this work. The other authors have no conflicts of interest to declare. (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/).) |
| Databáze: | MEDLINE |
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