Thrombectomy under protocol-based GA linked to less disability: JAMA Study

Delhi: The use of protocol-based general anaesthesia compared with procedural sedation was significantly associated with less disability at 3 months in patients with acute ischemic stroke undergoing thrombectomy, according to a recent study published in the JAMA journal.

General anaesthesia in patients undergoing for acute ischemic stroke is associated with poor neurological outcomes in nonrandomized studies. 3 single-centre randomized trials demonstrated no significant improvement in outcomes for patients who received general anaesthesia compared to procedural sedation.

Silvia Schönenberger, Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany, and colleagues detected differences in functional outcome at 3 months between patients who received general anaesthesia vs procedural sedation during thrombectomy for anterior circulation acute ischemic stroke.

The researchers searched the online databases for English-language articles published from January 1, 1980, to July 31, 2019. They included randomized clinical trials of adults with a National Institutes of Health Stroke Scale score of at least 10 and anterior circulation acute ischemic stroke assigned to receive general anaesthesia or procedural sedation during thrombectomy.

Individual patient data were obtained from 3 single-centre, randomized, parallel-group, open-label treatment trials with blinded endpoint evaluation that met inclusion criteria and were analyzed using fixed-effects meta-analysis.

A total of 368 patients (mean [SD] age, 71.5 [12.9] years; 163 [44.3%] women; median [interquartile range] National Institutes of Health Stroke Scale score, 17 [14-21]) were included in the analysis, including 183 (49.7%) who received general anesthesia and 185 (50.3%) who received procedural sedation.

Key findings include:

• The mean 3-month mRS score was 2.8 in the general anaesthesia group vs 3.2 in the procedural sedation group (difference, 0.43, 1.58).


• Among prespecified adverse events, only hypotension (decline in systolic blood pressure of more than 20% from baseline) (80.8% vs 53.1%) and blood pressure variability (systolic blood pressure >180 mm Hg or <120 mm Hg) (79.7 vs 62.3%) were significantly more common in the general anesthesia group.

"General anaesthesia during thrombectomy, compared with procedural sedation, was associated with less disability at 3 months after ischemic stroke, although the findings should be interpreted tentatively because the individual trials analyzed were single-centre trials and disability was the primary outcome in only 1 trial," concluded the authors.

More Information: "Association of General Anesthesia vs Procedural Sedation With Functional Outcome Among Patients With Acute Ischemic Stroke Undergoing Thrombectomy: A Systematic Review and Meta-analysis" published in the JAMA journal.

DOI:10.1001/jama.2019.11455

Journal Information: JAMA