Clinical efficacy of different anesthesia methods in patients with endovascular treatment for acute anterior circulation ischemic stroke: a meta-analysis
10.3760/cma.j.cn113694-20220804-00590
- VernacularTitle:不同麻醉方式对急性前循环缺血性卒中患者血管内治疗临床疗效影响的荟萃分析
- Author:
Xuan ZHAO
1
;
Ping YU
;
Zhaoteng NING
;
Zixiang GONG
;
Wang CHEN
;
Hongyang SUN
;
Xianjun WANG
;
Yan LIU
Author Information
1. 山东第一医科大学（山东省医学科学院）研究生部，济南 250117
- Keywords:
Anesthesia, general;
Conscious sedation;
Stroke;
Endovascular treatment;
Meta-analysis
- From:
Chinese Journal of Neurology
2023;56(5):532-542
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To systematically evaluate the efficacy and safety of general anesthesia versus conscious sedation in patients with endovascular therapy for acute ischemic stroke.Methods:Databases, including English databases PubMed, Embase and Cochrane, as well as Chinese databases Wan Fang Data and CNKI, were screened for randomized controlled trials (RCT) of general anesthesia versus conscious sedation on the effect of endovascular treatment for acute anterior circulation ischemic stroke. The searching period was from the establishment of databases to July 14, 2022. Two researchers independently screened literatures, extracted data and evaluated the risk of bias. And meta-analysis was performed using RevMan5.3 software.Results:A total of 7 RCTs involving 923 patients were included, with 461 in the general anesthesia group and 462 in the other. As the meta-analysis showing, general anesthesia could significantly improve the good outcomes (modified Rankin Scale score≤2) at 3 months after endovascular treatment in comparison with conscious sedation ( OR=1.34, 95% CI 1.01-1.78, P=0.04), and significantly increased the rate of successful revascularization ( OR=1.87, 95% CI 1.32-2.65, P<0.001). In addition, there were no statistically significant differences between the two groups in mortality ( OR=0.93, 95% CI 0.66-1.29, P=0.65), symptomatic intracranial hemorrhage ( OR=0.88, 95% CI 0.57-1.35, P=0.55) and intervention-related complications ( OR=0.83, 95% CI 0.50-1.36, P=0.46). However, general anesthesia was associated with higher risk for both 20% reduction in mean arterial pressure ( OR=4.76, 95% CI 1.49-15.19, P=0.008) and pneumonia ( OR=2.58, 95% CI 1.51-4.39, P<0.001). Conclusions:Compared with conscious sedation, endovascular treatment under general anesthesia in patients with acute anterior circulation ischemic stroke may contribute to better outcomes and higher successful revascularization. However, this method will lead to the risk of blood pressure variability and the incidence of pneumonia.
