From the Anesthesia and Intensive Care Department, Center of Clinical Investigation, Inserm, Rennes Teaching Hospital, Rennes, France.
University Rennes; the Radiology Department, Center of Clinical Investigation, Inserm, Rennes Teaching Hospital, Rennes, France.
Anesthesiology. 2022 Apr 1;136(4):567-576. doi: 10.1097/ALN.0000000000004142.
It is speculated that the anesthetic strategy during endovascular therapy for stroke may have an impact on the outcome of the patients. The authors hypothesized that conscious sedation is associated with a better functional outcome 3 months after endovascular therapy for the treatment of stroke compared with general anesthesia.
In this single-blind, randomized trial, patients received either a standardized general anesthesia or a standardized conscious sedation. Blood pressure control was also standardized in both groups. The primary outcome measure was a modified Rankin score less than or equal to 2 (0 = no symptoms; 5 = severe disability) assessed 3 months after treatment. The main secondary outcomes were complications, mortality, reperfusion results, and National Institutes of Health Stroke Scores at days 1 and 7.
Of 351 randomized patients, 345 were included in the analysis. The primary outcome occurred in 129 of 341 (38%) of the patients: 63 (36%) in the conscious sedation group and 66 (40%) in the general anesthesia group (relative risk, 0.91 [95% CI, 0.69 to 1.19]; P = 0.474). Patients in the general anesthesia group experienced more intraoperative hypo- or hypertensive episodes, while the cumulative duration was not different (mean ± SD, 36 ± 31 vs. 39 ± 25 min; P = 0.079). The time from onset and from arrival to puncture were longer in the general anesthesia group (mean difference, 19 min [i.e., -00:19] [95% CI, -0:38 to 0] and mean difference, 9 min [95% CI, -0:18 to -0:01], respectively), while the time from onset to recanalization was similar in both groups. Recanalization was more often successful in the general anesthesia group (144 of 169 [85%] vs. 131 of 174 [75%]; P = 0.021). The incidence of symptomatic intracranial hemorrhage was similar in both groups.
The functional outcomes 3 months after endovascular treatment for stroke were similar with general anesthesia and sedation. Our results, therefore, suggest that clinicians can use either approach.
据推测，血管内治疗中风的麻醉策略可能会对患者的预后产生影响。作者假设，与全身麻醉相比，在血管内治疗中风的过程中，接受镇静的患者在治疗后 3 个月的功能结局更好。
在这项单盲、随机试验中，患者接受标准化全身麻醉或标准化镇静。两组的血压控制也标准化。主要结局测量是治疗后 3 个月时改良 Rankin 评分≤2 分（0=无症状；5=严重残疾）。主要次要结局是并发症、死亡率、再灌注结果和第 1 天及第 7 天的国立卫生研究院卒中量表评分。
在 351 名随机患者中，345 名患者纳入分析。主要结局发生在 341 名患者中的 129 名（38%）：镇静组 63 名（36%）和全身麻醉组 66 名（40%）（相对风险，0.91[95%置信区间，0.69 至 1.19]；P=0.474）。全身麻醉组患者术中出现更多的低血压或高血压发作，但累计时间无差异（均值±标准差，36±31 比 39±25 分钟；P=0.079）。全身麻醉组患者的发病至穿刺时间和发病至到达时间较长（平均差值，19 分钟[即-00:19][95%置信区间，-0:38 至 0]和平均差值，9 分钟[95%置信区间，-0:18 至 -0:01]），而两组的发病至再通时间相似。全身麻醉组再通更常见（169 例中的 144 例[85%]比 174 例中的 131 例[75%]；P=0.021）。两组症状性颅内出血的发生率相似。
血管内治疗中风后 3 个月的功能结局在全身麻醉和镇静时相似。因此，我们的结果表明，临床医生可以使用这两种方法。
