Does choice of anaesthetic approach have an impact on neurological outcomes in stroke patients? This article, recently published in Stroke, examines outcomes in patients undergoing endovascular treatment for acute ischemic stroke, randomised to either conscious sedation or general anaesthesia.
Retrospective material till now has suggested poorer outcomes in patients subjected to full anaesthesia when compared to those who undergo sedation for endovascular procedures.
This trial, carried out by Henden et al, enrolled 90 patients with acute ischemic stroke for whom endovascular therapy was indicated. Patients were randomised to either sedation or general anaesthesia. Outcome measures were chiefly modified Rankin score, National Institutes of Health Stroke Scale and cerebral infarction volume.
Results—In the general anesthesia group 19 of 45 patients (42.2%) and in the conscious sedation group 18 of 45 patients (40.0%) achieved a modified Rankin Scale score ≤2 (P=1.00) at 3 months, with no differences in intraoperative blood pressure decline from baseline (P=0.57); blood glucose (P=0.94); PaCO2 (P=0.68); time intervals (P=0.78); degree of successful recanalization, 91.1% versus 88.9% (P=1.00); National Institutes of Health Stroke Scale score at 24 hours 8 (3–5) versus 9 (2–15; P=0.60); infarction volume, 20 (10–100) versus 20(10–54) mL (P=0.53); and hospital mortality (13.3% in both groups; P=1.00).
Quickly summarised, the trial did not demonstrate any significant difference in patient important outcomes. This leads us to conclude that there is no hard evidence to suggest that general anaesthesia confers any harm in this patient group.