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

作者：Silvia Schönenberger, Pia Löwhagen Hendèn, Claus Z. Simonsen, Lorenz Uhlmann, Christina Klose, Johannes Pfaff, Albert J. Yoo, Leif H. Sørensen, Peter A. Ringleb, Wolfgang Wick, Meinhard Kieser, Markus Möhlenbruch, Mads Rasmussen, Alexandros Rentzos, Julian Bösel · 发表于：JAMA · 年份：2019 · DOI：10.1001/jama.2019.11455 · 被引用次数：299 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Intensive Care Unit Cognitive Disorders

IMPORTANCE: General anesthesia during thrombectomy for acute ischemic stroke has been associated with poor neurological outcome in nonrandomized studies. Three single-center randomized trials reported no significantly different or improved outcomes for patients who received general anesthesia compared with procedural sedation. OBJECTIVE: To detect differences in functional outcome at 3 months between patients who received general anesthesia vs procedural sedation during thrombectomy for anterior circulation acute ischemic stroke. DATA SOURCE: MEDLINE search for English-language articles published from January 1, 1980, to July 31, 2019. STUDY SELECTION: Randomized clinical trials of adults with a National Institutes of Health Stroke Scale score of at least 10 and anterior circulation acute ischemic stroke assigned to receive general anesthesia or procedural sedation during thrombectomy. DATA EXTRACTION AND SYNTHESIS: Individual patient data were obtained from 3 single-center, randomized, parallel-group, open-label treatment trials with blinded end point evaluation that met inclusion criteria and were analyzed using fixed-effects meta-analysis. MAIN OUTCOMES AND MEASURES: Degree of disability, measured via the modified Rankin Scale (mRS) score (range 0-6; lower scores indicate less disability), analyzed with the common odds ratio (cOR) to detect the ordinal shift in the distribution of disability over the range of mRS scores. RESULTS: A total of 368 patients (mean [SD] age, 71....