Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China.
China Medical University, Shenyang, Liaoning Province, China.
J Clin Neurosci. 2021 Apr;86:10-17. doi: 10.1016/j.jocn.2021.01.012. Epub 2021 Jan 25.
Endovascular thrombectomy (EVT) is the first-line treatment for patients with acute ischemic stroke (AIS). However, the optimal anesthetic modality during EVT is unclear. Therefore, this systematic review and meta-analysis is aimed to summarize the current literatures from RCTs to provide new clinical evidence of choosing anesthetic modality for AIS patients when receiving EVT.
Literature search was conducted in following databases, EMBASE, MEDLINE, Web of Science, and the Cochrane Library, for relevant randomized controlled trials (RCTs) comparing general anesthesia (GA) and conscious sedation (CS) for AIS patients during EVT. We used the Cochrane Collaboration criteria for assessment of risk bias of included studies. The heterogeneity of outcomes was assessed by Istatistic.
5 RCTs with 498 patients were included. GA was conducted in 251 patients and CS in 247 patients. EVT under GA in AIS patients had higher rates of successful recanalization (RR: 1.13, 95% CI: 1.04-1.23; P = 0.004; I = 40.6%) and functional independence at 3 months (RR: 1.28, 95% CI: 1.05-1.55; P = 0.013; I = 18.2%) than CS. However, GA was associated with higher risk of mean arterial pressure (MAP) drop (RR: 1.71, 95% CI: 1.19-2.47; P < 0.01; I = 80%) and pneumonia (RR: 2.32, 95% CI: 1.23-4.37; P = 0.009; I = 33.5%). There was no difference between GA and CS groups in mortality at 3 months, interventional complications, intracerebral hemorrhage and cerebral infarction after 30 days.
GA was superior over CS in successful recanalization and functional independence at 3 months when performing EVT in AIS patients. However, GA was associated with higher risk of MAP drop and pneumonia. Therefore, results of ongoing RCTs will provide new clinical evidence of anesthetic modality selection during EVT in the future.
血管内血栓切除术（EVT）是急性缺血性脑卒中（AIS）患者的一线治疗方法。然而，EVT 期间的最佳麻醉方式仍不清楚。因此，本系统评价和荟萃分析旨在总结目前 RCT 文献，为接受 EVT 的 AIS 患者选择麻醉方式提供新的临床证据。
在 EMBASE、MEDLINE、Web of Science 和 Cochrane 图书馆中进行文献检索，以查找比较全身麻醉（GA）和镇静性意识保留（CS）用于 AIS 患者 EVT 的随机对照试验（RCT）。我们使用 Cochrane 协作组标准评估纳入研究的偏倚风险。通过 I ² 统计评估结果的异质性。
纳入了 5 项 RCT，共 498 名患者。GA 组 251 例，CS 组 247 例。AIS 患者行 GA 下 EVT 时，血管再通率（RR：1.13，95%CI：1.04-1.23；P=0.004；I=40.6%）和 3 个月时功能独立性（RR：1.28，95%CI：1.05-1.55；P=0.013；I=18.2%）更高。然而，GA 与平均动脉压（MAP）下降（RR：1.71，95%CI：1.19-2.47；P<0.01；I=80%）和肺炎（RR：2.32，95%CI：1.23-4.37；P=0.009；I=33.5%）风险增加相关。GA 组和 CS 组在 3 个月死亡率、介入并发症、30 天后颅内出血和脑梗死方面无差异。
在 AIS 患者行 EVT 时，GA 在血管再通率和 3 个月时的功能独立性方面优于 CS。然而，GA 与 MAP 下降和肺炎的风险增加相关。因此，未来正在进行的 RCT 结果将为 EVT 期间麻醉方式选择提供新的临床证据。
