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Outcomes of General Anesthesia and Conscious Sedation in Endovascular Treatment for Stroke

  • Caroline Just (a1), Philippe Rizek (a2), Peter Tryphonopoulos (a3), David Pelz (a4) and Miguel Arango (a3)...
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.

Résultats de l’anesthésie générale et de la sédation consciente dans le traitement endovasculaire de l’accident vasculaire cérébral. Contexte : Des études récentes ont montré clairement les bénéfices du traitement endovasculaire de l’accident vasculaire cérébral aigu ischémique (AVCI). Cependant le débat sur l’utilisation de l’anesthésie générale versus la sédation consciente (SC) lors de telles interventions se poursuit. Des études rétrospectives ont révélé que les résultats neurologiques étaient moins bons chez les patients qui avaient subi une anesthésie générale (AG). Cependant, selon certaines études, l’AVC était plus sévère chez ces patients. Méthodologie : Nous avons effectué une étude de cohorte rétrospective dans le but de comparer la mortalité et la morbidité de l’AG et celle de la SC chez des patients qui avaient subi une intervention endovasculaire pour un AVCI. Nous avons utilisé le test du chi-carré et le test de t pour analyser les données. Résultats : Les patients du groupe AG (n = 42) étaient plus susceptibles d’être décédés que ceux du groupe SC (n = 67) soit au moment du congé hospitalier, 3 mois et 6 mois après le début de l’AVC. La morbidité, évaluée au moyen du score modifié de Rankin, était significativement plus importante dans le groupe AG au moment du congé hospitalier et on notait une tendance similaire 3 mois après le congé hospitalier. Conclusion : L’anesthésie générale lors d’une intervention endovasculaire pour un AVCI était associée à une plus grande mortalité et à des résultats neurologiques moins bons par rapport à la sédation consciente. Dans notre étude, l’âge, le sexe, l’histoire d’hypertension, l’histoire de diabète et le score initial au National Institute of Health Stroke Scale n’étaient pas significativement différents entre les deux groupes. Bien qu’une étude prospective randomisée sur ce sujet soit nécessaire, notre étude corrobore la sécurité et l’efficacité de la SC lors de ces interventions.

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Corresponding author
Correspondence to: Caroline Just, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd, London ON, N6A 5A5, Canada. Email: Caroline.just@medportal.ca
References
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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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