Oxygen Saturation and Postoperative Mortality in Patients With Acute Ischemic Stroke Treated by Endovascular Thrombectomy

Comparison of anesthesia methods for intra-arterial therapy of patients with acute ischemic stroke: an updated meta-analysis and systematic review

OBJECTIVES

Currently, there remains debate regarding the optimal anesthesia approach for patients undergoing intra-arterial therapy for acute ischemic stroke. Therefore, we conducted a comparative analysis to assess the effects of general anesthesia versus non general anesthesia on patient outcomes.

METHODS

The research methodology entailed comprehensive searches of prominent databases such as the Cochrane Library, PubMed, Scopus, and Web of Science, covering the period from January 1, 2010, to March 1, 2024. Data synthesis employed techniques like risk ratio or standardized mean difference, along with 95% confidence intervals. The study protocol was prospectively registered with PROSPERO (CRD42024523079).

RESULTS

A total of 27 trials and 12,875 patients were included in this study. The findings indicated that opting for non-general anesthesia significantly decreased the risk of in-hospital mortality (RR, 1.98; 95% CI: 1.50 to 2.61; p<0.00001; I2 = 20%), as well as mortality within three months post-procedure (RR, 1.24; 95% CI: 1.15 to 1.34; p<0.00001; I2 = 26%), while also leading to a shorter hospitalization duration (SMD, 0.24; 95% CI: 0.15 to 0.33; p<0.00001; I2 = 44%).

CONCLUSION

Ischemic stroke patients who undergo intra-arterial treatment without general anesthesia have a lower risk of postoperative adverse events and less short-term neurological damage. In routine and non-emergency situations, non-general anesthetic options may be more suitable for intra-arterial treatment, offering greater benefits to patients. In addition to this, the neuroprotective effects of anesthetic drugs should be considered more preoperatively and postoperatively.

Oxygen saturation before and after mechanical thrombectomy and functional outcome in patients with acute ischemic stroke

Background and purpose

Currently, there is a lack of effective neuroprotective strategies to break the ceiling effect of mechanical thrombectomy (MT), and one of the most promising is normobaric oxygen treatment. However, the impact of pre- and post-MT oxygen saturation on clinical outcomes in patients with acute ischemic stroke (AIS) remains unclear. We aimed to determine the influence of preoperative and postoperative oxygen saturation on 3-month poor outcome in patients with AIS.

Methods

A total of 239 consecutive stroke patients with successful recanalization by MT between May 2017 and March 2021 were analyzed. Oxygen saturation was measured non-invasively by pulse oximetry at baseline and continually after MT. Regression analysis was used to assess the association of preoperative and postoperative oxygen saturation with a 3-month poor outcome (modified Rankin Scale score: 3–6).

Results

Decreased preoperative oxygen saturation level was associated with an increased risk of poor outcome (odds ratio, 0.85; 95% CI, 0.73–0.98; P = 0.0293). Postoperative oxygen saturation had the opposite effect on poor outcome (odds ratio, 1.60; 95% CI, 1.13–2.27; P = 0.0088).

Conclusion

Preoperative and postoperative oxygen saturation have different impacts on 3-month poor outcome in patients with AIS with successful recanalization by MT.

Stroke thrombectomy perioperative anesthetic and hemodynamic management

There is an ongoing debate about the optimal anesthetic and hemodynamic management of acute stoke patients with large vessel occlusion undergoing endovascular mechanical thrombectomy. Several prospective and retrospective analyses, and randomized controlled trials, attempted to address the challenges of using different anesthetic modalities in acute stroke patients requiring mechanical thrombectomy. We review the advantages and disadvantages of monitored anesthesia care, local anesthesia, conscious sedation, and general anesthesia, along with the relevance of hemodynamic management and perioperative oxygenation status in these complex patients.