Conscious sedation no better than general anesthesia in post-stroke endovascular treatment

Conscious sedation was not superior to general anesthesia for functional recovery in patients undergoing endovascular treatment following acute posterior circulation stroke, researchers reported in JAMA Neurology.

Fa Liang, MD, of the department of anesthesiology at Capital Medical University in Beijing, China, and colleagues sought to determine whether conscious sedation was an acceptable alternative to general anesthesia during endovascular treatment in those with acute posterior circulation stroke by conducting a randomized, parallel-group exploratory trial at two comprehensive care hospitals in China.

Of 210 patients with acute posterior circulation stroke admitted from March 2018 to June 2021, 87 (mean age, 62 years; 81.6% men) were included in the final analysis, of whom 43 underwent general anesthesia and 44 conscious sedation. The primary endpoint was functional independence after 90 days.

At baseline, the median participant score on the National Institute of Health Stroke Scale was 15. Thirteen patients (29.5%) in the conscious sedation group were transferred to the general anesthesia group.

The authors reported that although the conscious sedation group had a higher incidence of functional independence, there was no significant difference between the two groups, with analysis indicating that 48.8% of the general anesthesia group had a modified Rankin Score of 0 to 2 at 90 days vs. 54.4% in the conscious sedation group (RR = 0.89; 95% CI, 0.58-1.38 and adjusted OR = 0.91; 95% CI, 0.37-2.22).

However, general anesthesia performed better in successful reperfusion in intention-to-treat analysis (95.3%) compared with conscious sedation (77.3%), according to results (aOR = 5.86; 95% CI, 1.16-29.53).

“[Conscious sedation] was not better than [general anesthesia] for the primary outcome of functional recovery,” the authors wrote. “Moreover, [conscious sedation] was perhaps worse than [general anesthesia] for the secondary outcome of successful reperfusion.”