Effects of emergency conversion to general anesthesia on neurological outcomes of patients with acute ischemic stroke undergoing mechanical thrombectomy

doi:10.3969/j.issn.1006-7795.2023.02.009

Abstract

Abstract:

Objective To investigate the effects of emergency conversion to general anesthesia (EC-GA) on the neurological outcomes of patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT) and predictors of EC-GA. Methods A retrospective analysis was conducted on 422 patients with AIS who underwent mechanical thrombectomy in Beijing Tiantan Hospital, Capital Medical University from November 2017 to May 2021, including 203 cases in general anesthesia (GA), 173 cases in non-general anesthesia (non-GA)， and 46 cases in EC-GA. The primary outcome was the proportion of patients with Modified Rankin Scale (mRS)≤2 (mRS≤2 means good outcomes of neurological function) at 90 d after the operation. The secondary outcomes included time index ［onset-entry angiographic room time (T1), entry angiographic room-arterial puncture time (T2), arterial puncture-blood flow reperfusion time (T3)］, modified thrombolysis in cerebral infarction (mTICI):(0－2a indicating poor recanalization; 2b－3 indicating good recanalization), mortality (mortality at discharge and 90 d), postoperative complications (incidence of pneumonia and intracranial hemorrhage) and the predictors of EC-GA. Results Forty-six patients were encountered EA-GA with an overall conversion rate of 21.0%. The conversion rate of AIS patients with anterior circulation occlusion was approximately 19.0%, and that of posterior circulation was approximately 28.9%. There was no statistically significant difference in 90 d mRS and the proportion of good outcome (90 d mRS≤ 2) among the three groups (P>0.05), and the EC-GA group did not have significantly worse outcome with odds ratios: OR=1.538 (95% CI 0.792－2.984), compared with the non-GA group; OR=1.315 (95% CI： 0.684－2.528), compared with the GA group. National Institute of Health Stroke Scale (NIHSS)>15 (entry into angiographic room) was a predictor for EC-GA with an adjusted odds ratio (aOR) =2.005 (95% CI：1.035－3.881). Conclusion Emergency conversion to general anesthesia did not significantly increase the poor outcome compared with the non-GA group and GA group. Admission NIHSS>15 is a predictor for EC-GA.

Key words: anesthesia, emergency conversion to general anesthesia, acute ischemic stroke, mechanical thrombectomy, neurological outcome

CLC Number:

Liang Fa, Wu Youxuan, Wang Xinyan, Jian Minyu, Liu Haiyang, Han Ruquan. Effects of emergency conversion to general anesthesia on neurological outcomes of patients with acute ischemic stroke undergoing mechanical thrombectomy[J]. Journal of Capital Medical University, 2023, 44(2): 237-243.

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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2023.02.009

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2023/V44/I2/237

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