Anesthesiology Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
Anesthesiology Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
Clin Neurol Neurosurg. 2021 Mar;202:106494. doi: 10.1016/j.clineuro.2021.106494. Epub 2021 Jan 15.
Endovascular mechanical thrombectomy (EMT) is the standard of care for acute ischemic stroke (AIS) caused by proximal large vessel occlusions. There is conflicting evidence on outcome of patients undergoing EMT under procedural sedation (PS) or general anesthesia (GA). In this retrospective study we analyze the effect of GA and PS on the functional outcome of patients undergoing EMT.
Patients who have been admitted at our institute AIS and were treated with EMT under GA or PS between January 2015 and September 2018 were included in the study. Primary end point was the proportion of patients with good functional outcome as defined by a modified Rankin score (mRS) 0-2 at discharge.
A total of 155 patients were analyzed in this study including 45 (29.03 %) patients who received 97 GA, 110 (70.9 %) PS and 31 of these received Dexmedetomidine/Remifentanil. The median (IQR) 98 mRS at discharge was 4.0 (1.0-4.0) in the GA group Vs 3.00, (1.00-4.00) in the PS group. Among the secondary outcomes the lowest MAP recorded was significantly less in GA group (64.56 100 ± 18.70) compared to PS group (70.86 ± 16.30); p = 0.03. The PS group had a lower odd of mRS 3-5 (after adjustment), however, this finding was statistically not significant (OR 0.52 [0.07-3.5] 102 p = 0.5).
Our retrospective analysis did not find any influence of GA compared to PS whenever this was delivered by target controlled infusion (TCI) of propofol or by remifentanil/dexmedetomidine (REX) on early functional outcome.
血管内机械血栓切除术（EMT）是治疗近端大血管闭塞引起的急性缺血性脑卒中（AIS）的标准治疗方法。在接受 EMT 治疗时，患者在镇静（PS）或全身麻醉（GA）下的结果存在相互矛盾的证据。在这项回顾性研究中，我们分析了 GA 和 PS 对接受 EMT 治疗的患者功能结果的影响。
本研究纳入了 2015 年 1 月至 2018 年 9 月期间在我院因 AIS 住院并接受 GA 或 PS 下 EMT 治疗的患者。主要终点是出院时改良 Rankin 量表（mRS）评分 0-2 的患者比例，定义为功能良好的结果。
这项研究共分析了 155 例患者，其中 45 例（29.03%）患者接受 97 次 GA，110 例（70.9%）接受 PS，其中 31 例接受右美托咪定/瑞芬太尼。GA 组出院时中位数（IQR）mRS 为 4.0（1.0-4.0），PS 组为 3.00（1.00-4.00）。在次要结果中，GA 组记录的最低平均动脉压明显低于 PS 组（64.56±18.70 对 70.86±16.30）；p=0.03。PS 组 mRS 3-5 的几率较低，但统计学上无显著性差异（OR 0.52[0.07-3.5]102 p=0.5）。
我们的回顾性分析没有发现 GA 与 PS 之间的任何影响，无论 PS 是通过丙泊酚的目标控制输注（TCI）还是通过瑞芬太尼/右美托咪定（REX）给予，对早期功能结果都没有影响。
