Cargando…
Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis
BACKGROUND: Endovascular treatment in patients with acute anterior circulation stroke could be performed under either conscious sedation (CS) or general anesthesia (GA). Although several studies have investigated the association between the clinical outcomes and the two anesthesia methods, consensus...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2018
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346417/ https://www.ncbi.nlm.nih.gov/pubmed/30506982 http://dx.doi.org/10.1002/brb3.1178 |
_version_ | 1783389747528335360 |
---|---|
author | Li, Xuefei Hu, Zheng Li, Qian Guo, Yinping Xu, Shabei Wang, Wei He, Dan Luo, Xiang |
author_facet | Li, Xuefei Hu, Zheng Li, Qian Guo, Yinping Xu, Shabei Wang, Wei He, Dan Luo, Xiang |
author_sort | Li, Xuefei |
collection | PubMed |
description | BACKGROUND: Endovascular treatment in patients with acute anterior circulation stroke could be performed under either conscious sedation (CS) or general anesthesia (GA). Although several studies have investigated the association between the clinical outcomes and the two anesthesia methods, consensus is lacking. METHODS: PubMed and EMBASE searches were used to select full‐text articles comparing the effects of GA and CS on functional outcome and complications in patients with anterior circulation ischemic stroke. Enrolled patients were assigned to receive endovascular treatment with CS or GA, with a primary outcome of functional independency within 90 days. Secondary outcomes included intracranial hemorrhage, all‐cause mortality at 90 days, pneumonia, and intraprocedural complications. RESULTS: Thirteen studies (3 RCTs and 10 observational studies), which included 3,857 patients (CS = 2,129, GA = 1,728), were eligible for the analysis. The overall analysis including the RCTs and observational studies demonstrated that the functional independence within 90 days occurred more frequently among patients with CS compared with GA (OR, 1.42; 95% CI, 1.05–1.92, p = 0.02); and the risk of mortality was higher with GA compared with CS; furthermore, CS was associated with lower rate of intracranial hemorrhage. In RCTs, GA was associated with increased functional independence (OR, 0.55; 95% CI, 0.34–0.89, p = 0.01) and successful reperfusion (OR, 0.51; 95% CI, 0.30–0.89, p = 0.02). CONCLUSIONS: In the overall analysis and observational studies, CS was associated with improved functional outcomes and relatively safe for anterior ischemic stroke compared with GA. While the pooled data from RCTs suggested that GA was associated with improved outcomes. The inconsistency indicated that more large‐scale RCTs are required to evaluate what factors influenced the effect of the anesthesia methods on clinical outcomes. |
format | Online Article Text |
id | pubmed-6346417 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-63464172019-01-29 Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis Li, Xuefei Hu, Zheng Li, Qian Guo, Yinping Xu, Shabei Wang, Wei He, Dan Luo, Xiang Brain Behav Review Article BACKGROUND: Endovascular treatment in patients with acute anterior circulation stroke could be performed under either conscious sedation (CS) or general anesthesia (GA). Although several studies have investigated the association between the clinical outcomes and the two anesthesia methods, consensus is lacking. METHODS: PubMed and EMBASE searches were used to select full‐text articles comparing the effects of GA and CS on functional outcome and complications in patients with anterior circulation ischemic stroke. Enrolled patients were assigned to receive endovascular treatment with CS or GA, with a primary outcome of functional independency within 90 days. Secondary outcomes included intracranial hemorrhage, all‐cause mortality at 90 days, pneumonia, and intraprocedural complications. RESULTS: Thirteen studies (3 RCTs and 10 observational studies), which included 3,857 patients (CS = 2,129, GA = 1,728), were eligible for the analysis. The overall analysis including the RCTs and observational studies demonstrated that the functional independence within 90 days occurred more frequently among patients with CS compared with GA (OR, 1.42; 95% CI, 1.05–1.92, p = 0.02); and the risk of mortality was higher with GA compared with CS; furthermore, CS was associated with lower rate of intracranial hemorrhage. In RCTs, GA was associated with increased functional independence (OR, 0.55; 95% CI, 0.34–0.89, p = 0.01) and successful reperfusion (OR, 0.51; 95% CI, 0.30–0.89, p = 0.02). CONCLUSIONS: In the overall analysis and observational studies, CS was associated with improved functional outcomes and relatively safe for anterior ischemic stroke compared with GA. While the pooled data from RCTs suggested that GA was associated with improved outcomes. The inconsistency indicated that more large‐scale RCTs are required to evaluate what factors influenced the effect of the anesthesia methods on clinical outcomes. John Wiley and Sons Inc. 2018-12-03 /pmc/articles/PMC6346417/ /pubmed/30506982 http://dx.doi.org/10.1002/brb3.1178 Text en © 2018 The Authors. Brain and Behavior published by Wiley Periodicals, Inc. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Article Li, Xuefei Hu, Zheng Li, Qian Guo, Yinping Xu, Shabei Wang, Wei He, Dan Luo, Xiang Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis |
title | Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis |
title_full | Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis |
title_fullStr | Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis |
title_full_unstemmed | Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis |
title_short | Anesthesia for endovascular treatment in anterior circulation stroke: A systematic review and meta‐analysis |
title_sort | anesthesia for endovascular treatment in anterior circulation stroke: a systematic review and meta‐analysis |
topic | Review Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6346417/ https://www.ncbi.nlm.nih.gov/pubmed/30506982 http://dx.doi.org/10.1002/brb3.1178 |
work_keys_str_mv | AT lixuefei anesthesiaforendovasculartreatmentinanteriorcirculationstrokeasystematicreviewandmetaanalysis AT huzheng anesthesiaforendovasculartreatmentinanteriorcirculationstrokeasystematicreviewandmetaanalysis AT liqian anesthesiaforendovasculartreatmentinanteriorcirculationstrokeasystematicreviewandmetaanalysis AT guoyinping anesthesiaforendovasculartreatmentinanteriorcirculationstrokeasystematicreviewandmetaanalysis AT xushabei anesthesiaforendovasculartreatmentinanteriorcirculationstrokeasystematicreviewandmetaanalysis AT wangwei anesthesiaforendovasculartreatmentinanteriorcirculationstrokeasystematicreviewandmetaanalysis AT hedan anesthesiaforendovasculartreatmentinanteriorcirculationstrokeasystematicreviewandmetaanalysis AT luoxiang anesthesiaforendovasculartreatmentinanteriorcirculationstrokeasystematicreviewandmetaanalysis |