Association of General Anesthesia vs Procedural Sedation With Functional Outcome Among Patients With Acute Ischemic Stroke Undergoing Thrombectomy

Abstract

Quiz Ref ID Mechanical thrombectomy is standard of care for eligible patients with acute ischemic stroke caused by large vessel occlusion in the anterior circulation.¹ An unresolved matter is whether the choice of anesthetic strategy affects functional outcome. Proposed advantages of general anesthesia are patient immobilization, pain management, and airway protection. Disadvantages of general anesthesia are potential compromises in cerebral hemodynamics and intervention delay. Quiz Ref ID Proposed benefits of procedural sedation include clinical monitoring, stable hemodynamics, and a potentially shorter procedure. The disadvantages of procedural sedation, including unprotected airways and patient movement, may promote procedural complications and prolong the intervention. Retrospective studies^2-6 and meta-analyses^7,8 have suggested poorer functional outcome and higher mortality in patients who receive general anesthesia than procedural sedation. Differences in sedative agents (eg, type, dosage) were suggested to be associated with differences in functional outcome.⁹ However, these studies have been limited by selection bias (ie, confounding by indication) because patients with more severe stroke and poorer clinical presentation were more likely to receive general anesthesia. Furthermore, these nonrandomized studies did not focus primarily on details of anesthetic strategy.