Impact of anesthesia modality on functional outcome after endovascular therapy in patients with anterior circulation ischemic stroke aged 80 years and older: comparison between conscious sedation and general anesthesia
10.3760/cma.j.issn.1673-4165.2023.11.001
- VernacularTitle:麻醉方式对80岁及以上前循环缺血性卒中患者血管内治疗后功能转归的影响：清醒镇静与全身麻醉的比较
- Author:
Zhengwen CHEN
1
;
Xiaojian LU
;
Qingfeng HUANG
;
Junjie SHAO
Author Information
1. 南通大学附属医院卒中中心，南通 226001
- Keywords:
Ischemic stroke;
Endovascular procedures;
Thrombectomy;
Anesthesia, general;
Treatment outcome;
Elderly, over 80 years old
- From:
International Journal of Cerebrovascular Diseases
2023;31(11):801-806
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the impacts of conscious sedation and general anesthesia on the functional outcome after endovascular therapy (EVT) in elderly patients with acute ischemic stroke with large vessel occlusion (AIS-LVO).Methods:The clinical and imaging data of elderly patients with AIS-LVO (≥80 years) underwent EVT at the Affiliated Hospital of Nantong University from January 2020 to January 2023 were collected retrospectively. They were divided into conscious sedation group and general anesthesia group according to anesthesia modality, and divided into good outcome group (0-2 points) and poor outcome group (>2 points) based on the modified Rankin Scale score at 90 d after onset. The multivariate logistic regression analysis was used to investigate the impact of anesthesia modality on functional outcome after EVT. Results:A total of 77 elderly patients with AIS-LVO were enrolled, including 35 males (45.5%) and 42 females (54.5%); median age of 82.0 years (interquartile range, 80.0 to 84.0 years); the median baseline NIHSS score was 16.0 (interquartile range, 10.0-20.0). Conscious sedation was used in 21 cases (27.3%) and general anesthesia was used in 56 cases (72.7%); 17 (22.1%) had good outcome, while 60 (77.9%) had poor outcome. Compared with the general anesthesia group, the conscious sedation group had a longer procedure time (110.0 min vs. 89.0 min; P=0.049), but a higher rate of good outcome at 90 d (38.1% vs. 16.1%; P=0.038), a lower incidence of stroke-associated pneumonia (33.3% vs. 58.9%; P=0.045), and a lower proportion of patients who underwent tracheostomy after procedure (4.8% vs. 25.0%; P=0.046). Compared with the poor outcome group, the good outcome group had shorter procedure time (75 min vs. 99 min; P=0.033), lower incidence of stroke-associated pneumonia (29.4% vs. 58.3%; P=0.035), lower tracheotomy rate (0% vs. 25%; P=0.022), and a lower proportion of patients who received conscious sedation (47.1% vs. 21.7%; P=0.038). Multivariate logistic regression analysis showed that conscious sedation was an independent predictor of good outcome (odds ratio 0.090, 95% confidence interval 0.010-0.771; P=0.028). Conclusion:Conscious sedation may be more appropriate for elderly patients with anterior circulation AIS-LVO undergoing endovascular treatment.
