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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(04): s00441785693
DOI: 10.1055/s-0044-1785693
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General anesthesia versus conscious sedation in mechanical thrombectomy for patients with acute ischemic stroke: systematic review and meta-analysis

Anestesia geral versus sedação consciente na trombectomia mecânica para pacientes com AVC isquêmico agudo: revisão sistemática e metanálise
Ana Clara Felix De Farias Santos 
1   Universidad Privada Franz Tamayo, Facultad de Ciencias de la Salud, La Paz, Bolivia.
,
Luciano Lobão Salim Coelho 
2   UDI Hospital Rede D'Or São Luiz, São Luís MA, Brazil.
,
Guilherme de Carvalho Caldas 
3   Neurosurgical Innovations and Training Center, WCMC, New York, New York, United States.
,
Luziany Carvalho Araújo 
4   Ebserh, Universidade Federal de Pernambuco, Hospital das Clínicas,, Recife PE, Brazil.
,
Vivian Dias Baptista Gagliardi 
5   Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil.
,
Leonardo Augusto Carbonera 
6   Hospital Moinhos de Vento, Serviço de Neurologia e Neurocirurgia, Porto Alegre RS, Brazil.
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Abstract

Background After recently published randomized clinical trials, the choice of the best anesthetic procedure for mechanical thrombectomy (MT) in acute ischemic stroke (AIS) due to large vessel occlusion (LVO) is not definite.

Objective To compare the efficacy and safety of general anesthesia (GA) versus conscious sedation (CS) in patients with AIS who underwent MT, explicitly focusing on procedural and clinical outcomes and the incidence of adverse events.

Methods PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials (RCTs) comparing GA versus CS in patients who underwent MT due to LVO-AIS. Odds ratios (ORs) were calculated for binary outcomes, with 95% confidence intervals (CIs). Random effects models were used for all outcomes. Heterogeneity was assessed with I2 statistics.

Results Eight RCTs (1,300 patients) were included, of whom 650 (50%) underwent GA. Recanalization success was significantly higher in the GA group (OR 1.68; 95% CI 1.26–2.24; p < 0.04) than in CS. No significant difference between groups were found for good functional recovery (OR 1.13; IC 95% 0.76–1.67; p = 0.56), incidence of pneumonia (OR 1.23; IC 95% 0.56- 2,69; p = 0.61), three-month mortality (OR 0.99; IC 95% 0.73–1.34; p = 0.95), or cerebral hemorrhage (OR 0.97; IC 95% 0.68–1.38; p = 0.88).

Conclusion Despite the increase in recanalization success rates in the GA group, GA and CS show similar rates of good functional recovery, three-month mortality, incidence of pneumonia, and cerebral hemorrhage in patients undergoing MT.

Resumo

Antecedentes A trombectomia mecânica (TM) é o padrão de tratamento para pacientes com acidente vascular cerebral isquêmico agudo (AVCI) devido à oclusão de grandes vasos (OGV). No entanto, ainda não está claro qual é o procedimento anestésico mais benéfico para a TM.

Objetivo Nosso objetivo foi comparar a eficácia e a segurança da anestesia geral (AG) versus sedação consciente (SC) em pacientes com AVCI submetidos à TM, focando especificamente nos resultados procedimentais e clínicos, bem como na incidência de eventos adversos.

Métodos Foram realizadas buscas sistemáticas nas bases PubMed, Embase e Cochrane por ensaios clínicos randomizados (ECRs) comparando AG versus SC em pacientes submetidos à TM devido a AVCI por OGV. Razões de chances (ORs) foram calculadas para desfechos binários, com intervalos de confiança de 95% (ICs). Modelos de efeitos aleatórios foram usados para todos os resultados. A heterogeneidade foi avaliada com estatísticas I2.

Resultados Oito ensaios clínicos randomizados (1.300 pacientes) foram incluídos, dos quais 650 (50%) foram submetidos à AG. O sucesso da recanalização foi significativamente maior no grupo AG (OR 1,68; IC 95% 1,26–2,24; p < 0,04) em comparação com SC. No entanto, não houve diferença significativa entre os grupos para recuperação funcional adequada (OR 1,13; IC 95% 0,76–1,67; p = 0,56), incidência de pneumonia (OR 1,23; IC 95% 0,56- 2,69; p = 0,61), mortalidade em três meses (OR 0,99; IC 95% 0,73- 1,34; p = 0,95) ou hemorragia cerebral (OR 0,97; IC 95% 0,68- 1,38; p = 0,88).

Conclusão Apesar do aumento significativo nas taxas de sucesso de recanalização no grupo AG, AG e SC mostram taxas semelhantes de recuperação funcional, mortalidade, pneumonia e hemorragia em pacientes com AVCI submetidos à TM.

Keywords

Anesthesia, General - Conscious Sedation - Ischemic Stroke - Thrombectomy

Palavras-chave

Anestesia Geral - Sedação Consciente - AVC Isquêmico - Trombectomia

Authors' Contributions

ACFFS: conceptualization, data curation, formal analysis, methodology, resources, software, writing – original draft, writing – review & editing; LLSC: conceptualization, methodology, writing – original draft, writing – review & editing; GCC: conceptualization, data curation, formal analysis, methodology, software, writing – original draft, writing – review & editing; LCA: methodology, writing – original draft, writing – review & editing; VG: writing – original draft, writing – review & editing; LAC: conceptualization, data curation, investigation, methodology, project administration, writing – original draft, writing – review & editing.


Supplementary Material



Publication History

Received: 01 December 2023

Accepted: 25 February 2024

Article published online:
12 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Ana Clara Felix De Farias Santos, Luciano Lobão Salim Coelho, Guilherme de Carvalho Caldas, Luziany Carvalho Araújo, Vivian Dias Baptista Gagliardi, Leonardo Augusto Carbonera. General anesthesia versus conscious sedation in mechanical thrombectomy for patients with acute ischemic stroke: systematic review and meta-analysis. Arq Neuropsiquiatr 2024; 82: s00441785693.
DOI: 10.1055/s-0044-1785693
 

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