General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization

Janssen, Hendrik; Buchholz, Grete; Killer, Monika; Ertl, Lorenz; Brückmann, H.; Lutz, Juergen

doi:10.1007/s00270-016-1411-5

Cited by 15 publications

(4 citation statements)

References 24 publications

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“…In 11 (14.3%) of 77 patients, CS was converted to GA (12). To be consistent with the previous article, data for all patients were analyzed and reported as reported previously (9)(10)(11)13). However, these retrospective meta-analyses, in which patients were not randomized to a specific mode of sedation for EST, showed contradictory results.…”

Section: Analysis Of Interventional Datamentioning

confidence: 71%

Effect of General Anesthesia versus Conscious Sedation for Stroke Thrombectomy on Angiographic Workflow in a Randomized Trial: A Post Hoc Analysis of the SIESTA Trial

et al. 2018

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Purpose To investigate whether the sedation mode (ie, conscious sedation [CS] vs general anesthesia [GA]) affects the angiographic workflow applied for treatment of endovascular stroke in a post hoc analysis of a recent randomized controlled trial, Sedation versus Intubation for Endovascular Stroke Treatment (SIESTA). Materials and Methods SIESTA was an institutional review board-approved, single-center, prospective, randomized, parallel-group, open-label treatment trial with a blinded end-point evaluation to compare GA with CS for treatment of endovascular stroke in 73 and 77 patients, respectively. By using descriptive data from SIESTA, the influence of the mode of sedation on angiographic workflow during treatment for endovascular stroke (eg, procedure times) and other radiologic outcome parameters (eg, radiation exposure) were analyzed. The time between angiographic key steps for patients who underwent GA and CS was evaluated with t tests. P values were corrected for false discovery rate. Results The median time from groin puncture to first intracranial flow restoration with CS was 47 minutes (interquartile range [IQR], 29-70 minutes), and for GA, it was 41 minutes (IQR, 28-60 minutes) (P = .546). The median time to the end of angiography with CS was 104 minutes (IQR, 75-150 minutes), and with GA, it was 73 minutes (IQR, 53-125 minutes) (P = .052). Fluoroscopy time with CS was 49 minutes (IQR, 25-85 minutes), and with GA, it was 35 minutes (IQR, 20-74 minutes) (P = .098). The times were comparable in both groups for these measures. The time from groin puncture to the final angiographic result with GA, at 72 minutes (IQR, 45-109 minutes) was shorter than that with CS, at 98 minutes (IQR, 64-135 minutes) (P = .048). Conclusion This post hoc analysis of the single-center SIESTA trial revealed that time from groin puncture to final angiographic result was shorter with patients under GA than that with patients under CS. RSNA, 2017 Online supplemental material is available for this article.

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Section: Analysis Of Interventional Datamentioning

confidence: 71%

Effect of General Anesthesia versus Conscious Sedation for Stroke Thrombectomy on Angiographic Workflow in a Randomized Trial: A Post Hoc Analysis of the SIESTA Trial

et al. 2018

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“…Finally, 16 articles were included in the meta-analysis. [2][3][4][5][17][18][19][20][21][22][23][24][25][26][27][28] Detailed information on the baseline characteristics are described in Table 1. The mean age for each study ranged between 60.4 and 78.3 years.…”

Section: Literature Searchmentioning

confidence: 99%

Influence of Anesthesia Type on Outcomes after Endovascular Treatment in Acute Ischemic Stroke: Meta-Analysis

Kim

Kim²,

Jeon

2019

Neurointervention

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To assess clinical and angiographic outcomes after endovascular treatment (EVT) in ischemic stroke patients according to anesthesia types (general anesthesia vs. conscious sedation). Materials and Methods: A systematic literature review through an online data base between January 1990 and September 2017 was performed. A fixed effect model was used in cases of <50% heterogeneity. The primary outcomes were good clinical outcome at the 3-month follow-up and successful recanalization. A meta-regression analysis was done to estimate primary outcomes of log odds ratio (OR) on onset-to-puncture time (OTP) differences. Publication bias was determined using Begg's funnel plot and additional the Trim and Fill method. Results: Sixteen articles including 2,662 patients (general anesthesia, n=1,275; conscious sedation, n=1,387) were included. General anesthesia significantly decreased good outcomes than conscious sedation (OR, 0.564; 95% confidence interval [CI], 0.354-0.899). However, outcomes did not differ significantly in randomized controlled trials (RCTs; OR, 1.101; 95% CI, 0.395-3.071). Anesthesia type was not associated with successful recanalization (OR, 0.985; 95% CI, 0.787-1.233). General anesthesia increased the risk of mortality (OR, 1.532; 95% CI, 1. 187-1.976) and pneumonia (OR, 1.613; 95% CI, 1.172-2.221), but not symptomatic intracranial hemorrhage (OR, 1.125; 95% CI, 0.767-1.652). The meta-regression analysis showed no linear relationship between OTP differences and log OR of good outcome (coefficient, 0.0004; P=0.95) or successful recanalization (coefficient, 0.0005; P=0.94), respectively. Conclusion: General anesthesia seemed to be associated with adverse clinical outcome after EVT. However, its efficacy was not demonstrated in RCTs. Successful recanalization did not differ according to anesthesia type. Studies using individual patient data based on further RCTs are necessary to elucidate anesthesia effect on procedural and clinical outcomes.

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“…Both retrospective and prospective studies have shown that MAC has associated with better clinical outcomes. [54][55][56] However, other nonrandomized and randomized controlled trials did not show superiority of one method over the other. [57][58][59][60] A 2017 meta-analysis showed that there was no difference in GA versus non-GA in terms of neurological outcomes or 90-day mortality.…”

Section: Types Of Anesthesia Used In Endovascular Treatmentmentioning

confidence: 94%

A New Era of Extended Time Window Acute Stroke Interventions Guided by Imaging

Rehani

Ammanuel

Zhang

et al. 2019

The Neurohospitalist

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Ischemic stroke is one of the most debilitating and deadliest conditions worldwide. Intravenous t-PA is the current standard treatment within 4 hours after onset of symptoms. Recent randomized controlled trials have demonstrated the efficacy of neurointerventional intra-arterial treatment in acute ischemic stroke. About 20% of acute ischemic stroke are classified as wake-up strokes, which falls out of the conventional treatment time window. New evidence suggests that some patients with longer time from symptom onset (up to 24 hours) may benefit from thrombectomy, probably in part due to variations in collateral circulation among individual patients. Advanced imaging can play a crucial role in identifying patients who could benefit from endovascular intervention presenting within extended treatment time windows. In this article, we review the advanced imaging algorithm for ischemic stroke workup in the multiple studies published to date and summarize the results of the clinical trials for late ischemic stroke that can be clinically useful.

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General Anesthesia Versus Conscious Sedation in Acute Stroke Treatment: The Importance of Head Immobilization

Abstract: Mechanical thrombectomy can be performed faster and safely under CS in combination with simple head immobilization using a standard cervical collar.

Cited by 15 publications

References 24 publications

Effect of General Anesthesia versus Conscious Sedation for Stroke Thrombectomy on Angiographic Workflow in a Randomized Trial: A Post Hoc Analysis of the SIESTA Trial

Effect of General Anesthesia versus Conscious Sedation for Stroke Thrombectomy on Angiographic Workflow in a Randomized Trial: A Post Hoc Analysis of the SIESTA Trial

Influence of Anesthesia Type on Outcomes after Endovascular Treatment in Acute Ischemic Stroke: Meta-Analysis

A New Era of Extended Time Window Acute Stroke Interventions Guided by Imaging

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