General Anesthesia Versus Conscious Sedation and Local Anesthesia during Thrombectomy for Acute Ischemic Stroke
| Autor: | Rosa Musolino, Marco Petruzzelli, Roberto Gasparotti, Simona Sacco, Laura Greco, Monia Russo, Wiliam Auteri, Paolo Invernizzi, Andrea Giorgianni, Nicola Cavasin, Salvatore Mangiafico, Francesco Causin, Elvis Lafe, Guido Bigliardi, Mauro Bergui, Roberto Menozzi, Pietro Amistà, Antonio Pitrone, Lucio Castellan, Francesco Grillo, Valentina Saia, Umberto Scoditti, Manuel Cappellari, Paolo Cerrato, Maria Porzia Ganimede, Andrea Saletti, Rossana Tassi, Laura Malfatto, Maria Ruggiero, Andrea Zini, Angelica Tinelli, Ettore Nicolini, Claudio Baracchini, Chiara Comelli, Giuseppe Craparo, Alfonsina Casalena, Michelangelo Mancuso, Luca Allegretti, Adriana Critelli, Emanuele Malatesta, Dario Luca Lauretti, Anna Cavallini, Tiziana Tassinari, Patrizia Nencini, Mauro Magoni, Bruno Bonetti, Stefano Vallone, Giulio Guidetti, Marco Pavia, Danilo Toni, Rebecca Tinturini, Simona Corraine, Elisa Francesca Maria Ciceri, Fabrizio Sallustio, Pietro Filauri, Giovanni Pracucci, Ilaria Casetta, Edoardo Puglielli, Nunzio Paolo Nuzzi, Maurizio Versino, Delfina Ferrandi, Marina Mannino, Luigi Chiumarulo, Domenico Inzitari, Gigliola Chianale, Sandra Bracco, Stefano Forlivesi, Alfredo Petrone, Maria Carmela Spinelli, Alessandro De Vito, Luigi Simonetti, Sergio Nappini |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Anesthesia General/adverse effects Brain Ischemia/*therapy Endovascular Procedures/methods Sedation Ischemia Anesthesia General anesthesia Brain Ischemia Brain ischemia 80 and over medicine Humans odds ratio Local anesthesia conscious sedation groin thrombectomy Aged Aged 80 and over Endovascular Procedures Female Middle Aged Registries Stroke Thrombectomy General Adverse effect Advanced and Specialized Nursing Groin business.industry Ambientale medicine.disease medicine.anatomical_structure General/adverse effects Brain Ischemia/*therapy Endovascular Procedures/methods Anesthesia Anesthetic Neurology (clinical) medicine.symptom Cardiology and Cardiovascular Medicine business anesthesia conscious sedation groin odds ratio thrombectomy medicine.drug |
| Popis: | Background and Purpose: As numerous questions remain about the best anesthetic strategy during thrombectomy, we assessed functional and radiological outcomes in stroke patients treated with thrombectomy in presence of general anesthesia (GA) versus conscious sedation (CS) and local anesthesia (LA). Methods: We conducted a cohort study on prospectively collected data from 4429 patients enrolled in the Italian Registry of Endovascular Treatment in Acute Stroke. Results: GA was used in 2013 patients, CS in 1285 patients, and LA in 1131 patients. The rates of 3-month modified Rankin Scale score of 0–1 were 32.7%, 33.7%, and 38.1% in the GA, CS, and LA groups: GA versus CS: odds ratios after adjustment for unbalanced variables (adjusted odds ratio [aOR]), 0.811 (95% CI, 0.602–1.091); and GA versus LA: aOR, 0.714 (95% CI, 0.515–0.990). The rates of modified Rankin Scale score of 0–2 were 42.5%, 46.6%, and 52.4% in the GA, CS, and LA groups: GA versus CS: aOR, 0.902 (95% CI, 0.689–1.180); and GA versus LA: aOR, 0.769 (95% CI, 0.566–0.998). The rates of 3-month death were 21.5%, 19.7%, and 14.8% in the GA, CS, and LA groups: GA versus CS: aOR, 0.872 (95% CI, 0.644–1.181); and GA versus LA: aOR, 1.235 (95% CI, 0.844–1.807). The rates of parenchymal hematoma were 9%, 12.6%, and 11.3% in the GA, CS, and LA groups: GA versus CS: aOR, 0.380 (95% CI, 0.262–0.551); and GA versus LA: aOR, 0.532 (95% CI, 0.337–0.838). After model of adjustment for predefined variables (age, sex, thrombolysis, National Institutes of Health Stroke Scale, onset-to-groin time, anterior large vessel occlusion, procedure time, prestroke modified Rankin Scale score of Conclusions: GA during thrombectomy was associated with worse 3-month functional outcomes, especially when compared with LA. The inclusion of an LA arm in future randomized clinical trials of anesthesia strategy is recommended. |
| Databáze: | OpenAIRE |
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