A recently published review by our Danish colleagues sums up the more recent trials on the subject of anaesthetic technique for endovascular treatments for ischemic stroke. Older publications based largely on retrospective data have suggested harm from general anaesthesia (GA) for these procedures, when compared with conscious sedation (CS). In their review in Current Anesthesiology Reports, Rasmussen et al point to the fact that newer randomized data is more equivocal, showing similar outcomes in the CS and GA groups. This is in line with the findings of the AnStroke trial, which we covered some time back in this article.
Many of the older retrospective studies may be hampered by a certain amount of selection bias in the sense that the sicker patients a more likely to require GA in order to safely carry out the procedure. It seems logical to most anaesthetists that choice of anaesthetic technique should be tailored specifically to the individual patient´s needs, for endovascular therapies as for any other procedure. Some of our more unstable patients, with whom we might fear potential airway compromise, hypoventilation or unwarranted intra-procedural movement, would in all likelihood be best served with GA. These recent findings from high-quality prospective studies will hopefully put some of our doubts to rest and make us less reluctant to offer GA to patients in settings where we deem it to be the superior technique.
On the same subject I recommend the following three articles by the same group:
Rasmussen M, Espelund US, Juul N, Yoo AJ, Sørensen LH, Sørensen KE, et al. The influence of blood pressure management on neurological outcome in endovascular therapy for acute ischaemic stroke. Br J Anaesth. 2018.
Rasmussen M, Simonsen CZ, Sørensen LH, Dyrskog S, Rusy DA, Sharma D, et al. Anaesthesia practices for endovascular therapy of acute ischaemic stroke: a Nordic survey. Acta Anaesthesiol Scand. 2017;61(8):885–94.
Simonsen CZ, Yoo AJ, Sørensen LH, Juul N, Johnsen SP, Andersen G, et al. Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke. JAMA Neurol. 2018;75:470–7.