title: Outcomes of General Anesthesia and Conscious Sedation in Endovascular Treatment for Stroke.
abstract: Background Recent studies have strongly indicated the benefits of endovascular therapy for acute ischemic stroke, but what remains a continued debate is the role for general anaesthesia versus conscious sedation (CS) for such procedures. Retrospective studies have found poorer neurological outcomes in patients who underwent general anesthesia (GA); however, some have revealed worse baseline stroke severity in these patients. Methods This study is a retrospective cohort study aimed at comparing mortality and morbidity of GA versus CS in patients treated with endovascular intervention in acute ischemic stroke. Chi-square and t-test analyses were used. Results Patients in the GA (n=42) group were more likely to be deceased than those in the CS (n=67) group at hospital discharge, 3 months, and 6 months poststroke onset. Morbidity, as defined by modified Rankin Score, was significantly greater in the GA group at hospital discharge, and a similar trend was seen in morbidity at 3 months postdischarge. Conclusion General anesthesia for endovascular intervention in acute ischemic stroke was associated with increased mortality and poorer neurological incomes compared with conscious sedation. In our study, age, gender, history of hypertension, history of diabetes, and baseline National Institute of Health Stroke Scale were not significantly different between the groups. Although the need for a randomized, prospective study on this topic is clear, our study represents further corroboration of the safety and efficacy of conscious sedation in these procedures.
authors.affiliation: 1Clinical Neurological Sciences,Schulich School of Medicine Dentistry,Western University,London,Ontario,Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Just
authors.affiliation: 2Clinical Neurological Sciences,Western University,London,Ontario,Canada.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rizek
authors.affiliation: 3Department of Anesthesiology,Western University,London,Ontario,Canada.
authors.forename: Peter
authors.initials: P
authors.lastname: Tryphonopoulos
authors.affiliation: 4Department of Medical Imaging,Western University,London,Ontario,Canada.
authors.forename: David
authors.initials: D
authors.lastname: Pelz
authors.affiliation: 3Department of Anesthesiology,Western University,London,Ontario,Canada.
authors.forename: Miguel
authors.initials: M
authors.lastname: Arango
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D002545:Brain Ischemia / Q000150:complications; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
keywords: anaesthesia; cerebrovascular disease; cerebrovascular surgery; endovascular; interventional neuroradiology; neurosurgery - vascular; neurovascular; stroke