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Association of general anesthesia vs procedural sedation with functional outcome among patients with acute ischemic stroke undergoing thrombectomy: A systematic review and meta-analysis

JAMA Oct 10, 2019

Schönenberger S, Hendén PL, Simonsen CZ, et al. - In this individual patient data meta-analysis of three randomized clinical trials that involved 368 individuals with acute ischemic stroke in the anterior circulation, experts discovered variations in functional outcome at 3 months between patients who received general anesthesia vs procedural sedation during thrombectomy for anterior circulation acute ischemic stroke. A total of 368 individuals were involved in the analysis, comprising 183 who received general anesthesia and 185 who received procedural sedation. Amongst prespecified adverse events, in the general anesthesia group, only hypotension (decrease in systolic blood pressure of more than 20% from baseline) and blood pressure variability (systolic blood pressure > 180 mm Hg or < 120 mm Hg) were considerably more prevalent. Hence, the use of protocol-based general anesthesia, in comparison with procedural sedation, was considerably correlated with less disability at 3 months in individuals with acute ischemic stroke including the anterior circulation undergoing thrombectomy. Moreover, these findings should be decoded cautiously, provided that the singular trials investigated were single-center trials and the primary outcome in just one trial was disability.
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