AUTHOR=Peng Zhi , Luo Wenmiao , Yan Zhengcun , Zhang Hengzhu 

TITLE=The effect of general anesthesia and conscious sedation in endovascular thrombectomy for acute ischemic stroke: an updated meta-analysis of randomized controlled trials and trial sequential analysis

JOURNAL=Frontiers in Neurology

VOLUME=Volume 14 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1291211

DOI=10.3389/fneur.2023.1291211

ISSN=1664-2295

ABSTRACT=Objectives: General anesthesia (GA) and conscious sedation (CS) are common methods for endovascular thrombectomy (EVT) in acute ischemic stroke (AIS). However, the risks and benefits of each strategy are unclear. This study aims to summarize the latest RCTs and compare the postoperative effects of the two methods on EVT patients.
Material and methods: We systematically searched database to GA and CS in AIS patients during EVT. The retrieval time was from the creation of the database until March 2023. The quality of the studies was evaluated using the Cochrane Risk of Bias tool. Random-effects or fixed-effects meta-analyses were used to assess all outcomes.
Results: We preliminarily identified 304 studies, of which 8 were included. Based on the pooled estimates, there were no significant differences between the GA group and the CS group in terms of good functional outcomes (mRS0-2) and mortality rate at three months (RR=1.09, 95%CI: 0.95-1.24, P=0.23) (RR=0.95, 95%CI: 0.75-1.22, P=0.70), as well as in NHISS at 24 hours after treatment (SMD=-0.01，95%CI:-0.13-0.11, P=0.89). However, the GA group had better outcomes in terms of achieving successful recanalization of the blood vessel (RR=1.13, 95%CI: 1.07-1.19, P<0.0001). The RR value for the risk of hypotension was 1.87 (95%CI: 1.42-2.47, P<0.00001); for pneumonia, RR was 1.43 (95%CI: 1.07-1.90, P=0.01); and for symptomatic intracerebral hemorrhage, RR was 0.94 (95%CI: 0.74-1.26, P=0.68). The pooled RR value for complications after intervention was 1.03 (95%CI: 0.87-1.22, P=0.76). 
Conclusion: In patients undergoing EVT for AIS, GA and CS are associated with similar rates of functional independence. Further trials of larger scale are needed to confirm these findings.