18 Jan General Anesthesia vs Conscious Sedation for Endovascular Therapy of Stroke
MedicalResearch.com Interview with:
Dr. Claus Z. Simonsen, MD, PhD
Department of Neurology
Aarhus University Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Retrospective studies find worse outcome when performing (Endovascular Therapy) EVT under General Anesthesia (GA).
The main finding is that infarct growth in the Conscious Sedation (CS) and GA are not different. And that patients who had EVT under GA had a better outcome after 90 days. This is probably explained by better reperfusion rates under GA which was another part of the study that was surprising. Our neurointerventionalist are comfortable performing EVT under CS, but our study indicates that maybe it is easier to achieve reperfusion it the patient is anesthesized.
MedicalResearch.com: What should readers take away from your report?
Response: I am not advocating that EVT should be performed under GA. At our center, the vast majority of patients are managed under CS. But our findings can make people “less afraid” of GA. And when doing EVT under GA, we have found some blood pressure levels, where it is “safe”. EVT under GA is safe, provided you can intubate quickly and keep systolic blood pressure >140mmHg and MAP >70mmHg.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Examining if this our findings hold true if access to neuroanesthesiology is difficult.
MedicalResearch.com: Is there anything else you would like to add?
Response: It is interesting that we have so much retrospective data where experienced researchers have tried to exclude all confounders and here they find that EVT under GA is linked to worse outcomes. And then when randomized studies are performed (SIESTA, AnSTROKE and GOLIATH), the opposite is found to be true.
Simonsen CZ, Yoo AJ, Sørensen LH, Juul N, Johnsen SP, Andersen G, Rasmussen M. Effect of General Anesthesia and Conscious Sedation During Endovascular Therapy on Infarct Growth and Clinical Outcomes in Acute Ischemic StrokeA Randomized Clinical Trial. JAMA Neurol. Published online January 16, 2018. doi:10.1001/jamaneurol.2017.4474
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