The bevel of tracheal tubes operates as an airflow duct. If the bevel rotates a few degrees to the right or left, most of the tidal volume will go to the same side in VCV modes. This can lead to a significant paradox, with hyperinflation of one lung and hypoinflation of the other. We use 4-6 cc/kg as the default tidal volume in situations of decreased lung compliance, such as ARDS.
It is emphasized that using PCV modes in patients with ARDS may reduce complications. However, PCV modes require more sedation and analgesic drugs, which in a hypoxic patient, may exacerbate an unstable hemodynamic situation.
What is your opinion about the effects of the distal part of the tracheal tube on the diffusion of oxygen through the lungs? Consider tracheal tube bevels, even in a position facing you, where more of the tidal volume will go to the right lung due to the steeper angle and dilated right main bronchus, which produces lower resistance against airflow in VCV modes.
Anesthetic exposure during childhood is significantly associated with impairment of neurodevelopmental outcomes; however, the causal relationship and detailed mechanism of developmental anesthetic neurotoxicity remain unclear. Gut microbiota produces various metabolites and influences the brain function and development of the host. This relationship is referred to as the gut-brain axis. Gut microbiota may influence developmental anesthetic neurotoxicity caused by sevoflurane exposure. This study investigated the effect of changes in the composition of gut microbiota after fecal microbiota transplantation on spatial learning disability caused by developmental anesthetic neurotoxicity in neonatal rats.
METHODS:
Neonatal rats were allocated into the Control (n = 10) and Sevo (n = 10) groups in Experiment 1 and the Sevo (n = 20) and Sevo+FMT (n = 20) groups in Experiment 2, according to the randomly allocated mothers’ group. The rats in Sevo and Sevo+FMT groups were exposed to 2.1% sevoflurane for 2 hours on postnatal days 7 to 13. Neonatal rats in the Sevo+FMT group received fecal microbiota transplantation immediately after sevoflurane exposure on postnatal days 7 to 13. The samples for fecal microbiota transplantation were obtained from nonanesthetized healthy adult rats. Behavioral tests, including Open field, Y-maze, Morris water maze, and reversal Morris water maze tests, were performed to evaluate spatial learning ability on postnatal days 26 to 39.
RESULTS:
Experiment 1 revealed that sevoflurane exposure significantly altered the gut microbiota composition. The relative abundance of Roseburia (effect value: 1.01) and Bacteroides genus (effect value: 1.03) increased significantly after sevoflurane exposure, whereas that of Lactobacillus (effect value: −1.20) decreased significantly. Experiment 2 revealed that fecal microbiota transplantation improved latency to target (mean ± SEM; Sevo group: 9.7 ± 8.2 seconds vs, Sevo+FMT group: 2.7 ± 2.4 seconds, d=1.16, 95% confidence interval: −12.7 to −1.3 seconds, P = .019) and target zone crossing times (Sevo group: 2.4 ± 1.6 vs, Sevo+FMT group: 5.4 ± 1.4, d=1.99, 95% confidence interval: 2.0–5.0, P < .001) in the reversal Morris water maze test. Microbiota analysis revealed that the α-diversity of gut microbiota increased after fecal microbiota transplantation. Similarly, the relative abundance of the Firmicutes phylum (effect value: 1.44), Ruminococcus genus (effect value: 1.69), and butyrate-producing bacteria increased after fecal microbiota transplantation. Furthermore, fecal microbiota transplantation increased the fecal concentration of butyrate and induced histone acetylation and the mRNA expression of brain-derived neurotrophic factor in the hippocampus, thereby suppressing neuroinflammation and neuronal apoptosis.
CONCLUSIONS:
The alternation of gut microbiota after fecal microbiota transplantation influenced spatial learning ability in neonatal rats with developmental anesthetic neurotoxicity. Modulation of the gut microbiota may be an effective prophylaxis for developmental anesthetic neurotoxicity in children.
Pain management is essential in trauma. Sufentanil is a potent sublingual opioid analgesic with no active metabolites and rapid onset relative to oral medications. We hypothesize that compared to standard care, Sufentanil reduces the verbally administered numerical pain scale (VNRS) at 30 minutes.
METHODS:
We performed a prospective multicenter, open-label, randomized trial utilizing level-1 trauma centers from within the Linking Investigator in Trauma and Emergency Services (LITES) network. Participants were randomly assigned in a 1:1 ratio to either sublingual sufentanil or standard care. We enrolled 150 patients from July 2022 to January 2024. The study was approved by the human subjects research protection offices of the University of Pittsburgh and the Department of Defense. Subjects were eligible if they had a trauma evaluation, were 18 to 70, had a VNRS (0–100) score ≥50, and remained in the ED for at least 30 minutes. We excluded patients who were prisoners, pregnant, allergic to opioids, required airway management, body mass index (BMI) >40, significant respiratory depression, suspected gastrointestinal obstruction, or other contraindication to analgesics. The primary outcome was the VNRS for clinical pain measurement (0–100) at 30 minutes after treatment. Secondary outcomes included adverse events (hypoxia, hypotension, need for airway management) and the incidence of nausea/vomiting/headache/dizziness requiring treatment. We hypothesize that sublingual sufentanil as compared to emergency department standard care, will reduce the VNRS at 30 minutes.
RESULTS:
The study population had a mean age of 48 years (standard deviation [SD] 15) and was 32% female. The mechanism of injury was mostly blunt (96%). The VNRS at 30 minutes was 67 (SD 25) for the entire cohort, 66 (SD 23) in the sufentanil group, and 68 (SD 27) in the standard care group (P = .37). The Health care Professional Global Assessment (HPGA) at 30 minutes showed decreased pain scores in the standard care group compared to sufentanil, with standard care having more patients scored as good or excellent (P = .009). There was no difference in the incidence of nausea, vomiting, headache, dizziness, hypoxia, hypotension, or need for an advanced airway.
CONCLUSIONS:
In this cohort of trauma patients with moderate to severe pain, the VNRS at 30 minutes after administration of analgesics did not differ between sublingual sufentanil and standard care. Adverse events did not differ between the groups suggesting the sublingual sufentanil in this population.
Over 75% of surgeries worldwide are elective and unplanned ICU admissions after these surgeries pose a major—albeit rare—challenge. However, few epidemiological studies have focused on patients requiring unplanned ICU admission directly from the operating room after elective surgeries are lacking. This study uses the Japanese Intensive Care Patient Database (JIPAD) to describe unplanned ICU admissions after elective surgeries.
METHODS:
We conducted a multicenter retrospective cohort study using data from the JIPAD from April 2015 to March 2022, focusing on patients with unplanned ICU admissions after elective surgery. Collected variables included patient characteristics, treatments, outcomes, reasons for ICU admission, and type of surgery. We categorized the reasons for ICU admission into 9 types: anaphylaxis, hemorrhage, anesthesia-related complications, respiratory-related complications, cardiovascular-related complications, neurological-related complications, surgical-related complications, electrolyte/acid-base abnormalities, and unknown causes. The type of surgery was classified using JIPAD definitions.
RESULTS:
Among 141,969 patients in the JIPAD who underwent elective surgery, 2666 patients (1.9%) required an unplanned ICU admission. Cardiac arrest before ICU admission occurred in 52 patients (2.0%), the median APACHE III score was 51, and 1218 patients (45.7%) required postoperative mechanical ventilation. The median hospital stay for patients with unplanned ICU admission was 21 days and in-hospital mortality was 3.3% (88/2666). The most common reason for ICU admission was respiratory complications (n = 440, 16.5%), followed by hemorrhage (n = 377, 14.1%). Cardiovascular-related complications had the highest in-hospital mortality at 6.8% (20/294). Hospital mortality exceeded ICU mortality, suggesting that patients expected to derive limited benefit from intensive care may have been transitioned out of the ICU to accommodate other patients with greater need. The most frequent surgeries requiring unplanned ICU admission were for gastrointestinal neoplasms (n = 464, 17.4%), followed by orthopedic surgeries (n = 303, 11.4%). Anaphylaxis occurred across a broad spectrum of surgeries. Respiratory-related complications were common in patients with other respiratory diseases and accounted for over half of the total number of cases according to surgery type. Neurological-related complications were most frequent in craniotomies for neoplasms.
CONCLUSIONS:
In our review of a nationwide ICU database from 2015 to 2022 we identified a 1.9% rate of unplanned ICU admission and found that mortality varied according to the reasons for ICU admission. Respiratory-related complications were most common, and cardiovascular complications were most associated with in-hospital mortality. Further research may help us to better understand the epidemiology of unplanned ICU admission after surgery.
If you’re an anesthesiologist searching for a balanced lifestyle and rewarding work, you’ll want to check out this opportunity. Our all-anesthesiologist group is seeking a dedicated team member to join our collaborative practice.
Position Highlights:
Zero Call for 3 Weeks: Enjoy three weeks of no call duty, followed by one week of call. Even during your call week, there’s no daytime work—just coverage after 7 PM, so you may not work the entire week.
Competitive Compensation: Earn a $500,000 annual salary plus a comprehensive benefits package.
Work-Life Balance: Enjoy 8 weeks of vacation each year to recharge and relax.
Team-Based Approach: Join a cohesive group of 4 full-time anesthesiologists and 1 vacation relief provider, managing 3 operating rooms.
This role provides the perfect mix of professional fulfillment and personal freedom, with a supportive environment and a predictable schedule.
Interested?
Let’s connect! Contact Dr. Rob at 660-596-2224 or drrob@anesthesiaexperts.com for more details or to apply. Feel free to pass this along to any colleagues who might be interested.
This is a rare opportunity—don’t miss your chance to join a team that values your skills and respects your time!
We’re excited to announce the formation of a new anesthesia group in Riverdale, GA, located just 10 minutes from the Atlanta Airport. We’re seeking dedicated CRNAs to join our collaborative care team, which will include 4 full-time CRNAs and 2 anesthesiologists managing 4 operating rooms. This is a 25% independent practice and doing own blocks!
Position Highlights:
Case Mix: Bread-and-butter cases – no heads, hearts, trauma, or OB.
Call Schedule: Call is from home with only a 10% chance of being called back.
Work Environment: Enjoy a supportive and collegial workplace.
This is an excellent opportunity to be part of a close-knit team and establish yourself in a fantastic community near Atlanta.
Interested?
Please reach out to Dr. Rob at 660-596-2224 or drrob@anesthesiaexperts.com. Feel free to share this opportunity with anyone who might be interested!
The isolated forearm technique (IFT) was introduced by Tunstall in the 1970s as a means to provide anesthetized patients paralyzed with neuromuscular blockade (NMB) the ability to communicate, if perchance they were accidentally aware. In IFT a cuff temporarily isolates a forearm from the circulation after anesthetic induction but before administration of NMB. Although the IFT was thus introduced as a means to monitor accidental awareness patients are not reported to move their isolated hand spontaneously despite putatively painful surgery but surprisingly perhaps, only in response to verbal command (calling their name; see https://www.youtube.com/watch?v=ZEAYsEbkJrw). This response is readily reproducible at some point during surgery after anesthesia induction—in up to a third of patients overall across 31 studies in ~11% of patients in the period immediately after induction. The precise reasons for this are still debated, but this apparently paradoxical response (ie, to verbal command, but not to pain) offers some insights into possible mechanisms of anesthesia-induced consciousness.
Yet previously it has been reported that in the absence of NMBs (nonparalyzed, spontaneously breathing, anesthetized patients), there is no response to verbal command but there can be movement during stimulating periods of surgery. Thus in absence of NMBs, an inverse pattern is seen (response to pain, but not to verbal command). That previous study did not use any processed electroencephalogram (pEEG) monitoring, leaving open the possibility that those results—opposite as they were to the IFT results with NMB—arose due to excessive depth of anesthesia.
This observational study was designed to assess if, in a group of patients with a suitable depth of anesthesia as indicated by pEEG, it is possible to elicit a response to verbal command in nonparalyzed patients
METHODS
After ethical permission and written informed consent 200 suitable, consecutive adult urology patients were observed. As there were no experimental interventions, and no change to normal clinical practice, this study was classed as an observational audit (#6643). In line with UK minimum monitoring guidance, patients were informed that the anesthetist would be checking they were asleep by calling their name at intervals. Patients were excluded if American Society of Anesthesiologists (ASA) physical status III/IV, obese (body mass index [BMI] >35), had neurological or psychiatric illness or required use of NMB. Patients who were hard of hearing and non-English speakers were excluded from the recording of observations.
After placement of routine monitors, including bispectral index (BIS) anesthesia was induced with fentanyl 1 to 2 µg kg-1 and propofol 2 to 3 mg.kg-1, followed by insertion of a supraglottic airway (SGA). Anesthesia was maintained with isoflurane in oxygen/air (30% inspired oxygen fraction), titrated to clinical signs (in practice between ~0.5%–1.5% end-tidal). Additional analgesia (fentanyl) or anesthesia (propofol or isoflurane) was provided if judged clinically necessary.
Figure 1 flowchart shows how patients were managed with respect to IFT commands. After induction, any (a) movement contiguous with verbal command (+ve IFT) or (b) spontaneous movement were noted, along with BIS value at that moment, at the following time points: (i) jaw manipulation to facilitate SGA insertion; (ii) after SGA placement; (iii) at emergence. During surgery, IFT commands were given every 2 minutes and additionally if at any time the patient moved separately, spontaneously to the stimulus of surgery. Any patient who moved spontaneously required anesthesia to be deepened and so was excluded from further study observation.
Observational flowchart showing timings for verbal commands, and patient responses.
Binomial modeling indicates that even with a minimum (conservative) expected positive IFT rate of 5% (half that previously reported) this sample size had a >99.4% chance of observing at least 1 positive IFT response, and an 88% chance of observing at least 3. Expressed another way, the chance of failing to observe any responses by chance was just 0.6%.
RESULTS
All patients were ASA physical status II to II (males 68%; median [interquartile range {IQR} {range}] age 73 [66–78] [23–93]) years, mean (standard deviation [SD]) weight 76.7 (14.2) kg). Operations included: cystoscopy, transurethral resection of bladder tumor, transurethral resection of prostate, ureteroscopy for biopsy or stone removal, hydrocoele, circumcision, suprapubic catheter insertion, all of which were <120 minutes duration. The mean (SD) initial induction dose of propofol was 2.5 (0.4) mg/kg, and 100–150μg fentanyl total.
The salient observation was that no patient moved to verbal command at any time during anesthesia or surgery (Figure 1). Yet the incidence of spontaneous movement, consistent with lighter planes of anesthesia (limb jerks, head or facial movement) was high (52% overall). The BIS values also did not reflect excessively deep anesthesia (Figure 2; Supplemental Digital Content 1, Supplement S1, https://links.lww.com/AA/F211).
BIS values immediately after IV induction, after SGA insertion and in minute after surgery was complete (emergence). Boxplots show the median (horizontal line), interquartile range (edges of box), 90% centiles (error bars), and range (dots). The horizontal lines y-axis 40 to 60 indicate the generally accepted limits for BIS for adequate anesthesia. The numerical BIS values at the timepoints are presented in Figure 1. BIS indicates bispectral index; IV, intravenous; SGA, supraglottic airway.
Patients were generally comfortable in recovery, requiring only hyoscine hydrobromide (0–20 mg) for urinary spasm symptoms or fentanyl (0–25 µg) for analgesia. All patients were satisfied with surgery and anesthesia (there were no surgical complications) and none had recall (Brice interview); 36 stayed overnight, also without recall the next day.
DISCUSSION
On one level this report is a trivial, formalized description of what practitioners already know: that their nonparalyzed patients do not move during surgery if we call their name. We do know, however, that these same patients sometimes move in response to surgical stimulus.
What is nontrivial is that this is in striking contrast to what has been repeatedly observed using IFT in patients who receive NMBs. Clearly, the use of NMB is essential to obtain a positive IFT response-to-command. This apparently paradoxical absence of response to command in the nonparalyzed might be artefactual, dependent on individual variability, or physiological conditions but it cannot here be explained by excessive anesthesia. Regardless, the challenge remains for any anesthesiologist, anywhere, to report a single patient moving in response to verbal command, when spontaneously breathing via SGA during surgery.
Criticisms include that this was a single-operator study, with potential for bias, with no tight control of dosing or agents. A controlled trial, with one group receiving NMB, including non-English speakers and embracing a wider range and duration of surgeries might conceivably yield different results. Specific BIS values and end-tidal isoflurane concentrations were not measured at precise moments of spontaneous movement or light anesthesia. In this regard, patients who moved to surgical stimulus were excluded from further IFT observations (Figure 1) for the clinically appropriate reason that anesthesia was deepened to prevent further lightening. In one respect this was a strength of the study: patients who moved to stimulus were those most expected at that timepoint also to move to verbal command, so the fact they did not is strong evidence of a paradoxical response pattern. However, another perspective is that these patients may be the most prone to moving in all circumstances, so an opportunity may have been missed to capture a later response to verbal command. Also when NMBs are used, it is necessary temporarily to use a cuff on the forearm, but its absence in this report unlikely explains the lack of response to verbal command. All these limitations can be overcome simply by someone reporting a contrary finding.
It is a limitation that the pEEG raw values were not analyzed by spectrogram. Although given the “no-response” it is unclear what this would have shown, especially since even in IFT using NMB, Gaskell et al found no difference between responders and nonresponders. That said, the reported values of EEG parameters for responders in Gaskell et al suggested possibly light depths of anesthesia at moments of response, in the IFT-positive patients. Together with the findings of this study, this suggests that EEG monitoring should be undertaken with caution in the presence of NMBs. This conclusion in turn is consistent with the report of Schuller et al who found BIS values misleadingly as low as 44 in awake volunteers, paralyzed with NMB (with isolated forearm).
It is well known that the neural pathways mediating auditory and nociceptive stimuli are distinct, and anesthesia interacts with each differently. The observations here raise the possibility that NMB influences this anesthetic interaction in a highly specific, but as yet undefined way. Without specifying any model, if response-to-verbal-command (as with IFT with NMB) implies a more aroused state than with no-response, then the results presented here suggest NMB acts to increase the arousal state.
The Simple Postoperative AKI Risk (SPARK) index is a novel model for predicting risk of postoperative acute kidney injury (PO-AKI) among patients after noncardiac surgery. However, the performance of the index has been inconsistent partly due to heterogeneity in case mix and effects of the involved clinical features. To clarify potential reasons for poor performance, we tested the SPARK index in a cohort of high-risk patients requiring intensive care unit (ICU) care after noncardiac surgery and examined whether model modification by refitting coefficients of clinical features could optimize model performance.
METHODS:
This was a single-center prospective cohort study. Preoperative variables of the SPARK index were extracted from electronic medical records. PO-AKI was defined by an increase in sCr ≥26.5 mmol/L within 48 hours or 150% compared with the preoperative baseline value within 7 days after surgery, whereas critical AKI was defined as AKI stage 2 or greater and/or any AKI connected to postoperative death or requiring renal replacement therapy during the hospital stay. Discrimination was evaluated by the area under the receiver operating characteristic curve (AUC), and calibration was evaluated by the Hosmer–Lemeshow χ2 test and calibration plot. Model modification was performed by rebuilding the model with the original variables of the SPARK index through proportional odds logistic regression among participants in the earlier study period and was validated in the later one.
RESULTS:
A total of 973 patients were enrolled, among whom 79 (8.1%) PO-AKI cases and 14 (1.4%) critical AKI cases occurred. Our study participants demonstrated a higher SPARK risk score than the SPARK discovery cohort (eg, 8.02% vs 1.20% allocated in the highest risk group), and the incidence of both outcomes increased through the classes of the score (incidence proportion of PO-AKI increased from 2.56% in the lowest risk group to 25.64% in the highest risk group). The AUCs for PO-AKI and critical AKI were 0.703 (95% confidence interval [CI], 0.641–0.765) and 0.699 (95% CI, 0.550–0.848), respectively. The sensitivity, specificity, negative predictive value and positive predictive value were 68.35%, 57.49%, 95.36%, and 12.44%, respectively, when using 10% of predicted probability of PO-AKI as threshold. Calibration plots suggested acceptable consistency between the predicted and actual risk. After model modification, external validation demonstrated a significantly improved AUC for PO-AKI.
CONCLUSIONS:
The SPARK index showed fair discrimination and calibration among patients admitted to the ICU after noncardiac surgery. Modification of the model improved the performance of the model in terms of predicting PO-AKI.
KEY POINTS
Question: Can the Simple Postoperative AKI Risk (SPARK) index be applied to patients in more severe situation admitted to the ICU after noncardiac surgery?
Findings: The SPARK index in its original form showed fair discrimination and calibration among patients with older age and higher comorbidity. Further modification by refitting the model suggested improvement of its performance.Meaning: The SPARK index can be modified for use for preoperative AKI risk classification in patients with more severe comorbidities and population-specific modifications to the index can further enhance index performance.
Increased specialty competitiveness, alongside the inception of virtual interviews, has increased the number of applications submitted to the Electronic Residency Application Service (ERAS) in anesthesiology. ERAS introduced signals to provide applicants with a means to demonstrate interest in a select group of residency programs. In the 2023 to 2024 application cycle, anesthesiology applicants had the opportunity to send 5 gold and 10 silver signals in a tiered system.
METHODS:
This multicenter, cross-sectional (exempt) research survey was created by members of the executive council of the Association of Anesthesiology Core Program Directors (AACPD) and housed and distributed through REDCap and the University of Nebraska Medical Center. Publicly available contact information of anesthesiology core program directors was obtained from the Accreditation Council for Graduate Medical Education (ACGME) website and membership roster of the AACPD. In total, 174 anesthesiology programs were identified. A survey invitation was distributed on March 12, 2024, to all programs via e-mail with reminders. The survey closed on April 30, 2024. Survey responses were collected anonymously, with instructions to provide 1 response per program. All statistical summaries and analyses were performed using SAS 9.3 (SAS Institute).
RESULTS:
The survey was sent to all 174 identified programs, with a response rate of 48.9%. Small programs were defined as having <44 residents, medium 44 to 62 residents, and large >62 residents. Small programs received significantly fewer applications (median 1255) than medium (1420) and large (1558) programs (P = .0005). There was a statistically significant difference in the number of gold signals received based on program size, with large programs receiving significantly more than medium (169 vs 116, P = .0238) or small programs (168 vs 71, P < .0001). Applicants sending gold signals were more likely to receive an interview compared to those who sent silver signals (56.7% vs 31%, P ≤ .0001). Of the those interviewed, applicants who sent gold signals comprised 42% (28.7%–52.6%), whereas applicants who sent silver signals comprised 45.5% (33%–54.7%). Applicants who did not send a program signal but signaled geographically made up a smaller portion of the interview group at 3% (0%–15.4%). The percentage of matched residents sending gold signals made up 66.7% (47.1%–82.4%) of a program’s match list, whereas those sending silver signals were 25% (11.1%–33.3%) of the matched cohort.
CONCLUSIONS:
Anesthesiology applicants who sent program signals were selected for a large majority of available interview positions, and interviewed applicants who submitted gold and silver signals comprised the vast majority of matched resident cohorts.
Total intravenous anesthesia (TIVA)-based and volatile-based general anesthesia have different effects on cerebral hemodynamics. The current work compares these 2 regimens in acute ischemic stroke patients undergoing endovascular therapy.
METHODS:
We conducted a systematic literature search across MEDLINE, Embase, Cochrane, CINAHL, Web of Science, and Scopus. We identified English language studies including adult acute ischemic stroke patients managed with endovascular therapy under general anesthesia delineable into TIVA only and/or volatile only, and obtained categorical data for favorable functional outcomes using the modified Rankin scale (mRS ≤2), at 90 days after endovascular therapy. Odds ratios (OR) and standardized mean differences were calculated to inform a network meta-analysis approach, which permitted the inclusion of studies comparing a form of general anesthesia (ie, TIVA only or volatile only) to conscious sedation.
RESULTS:
The search rendered 6235 articles, of which 15 met inclusion criteria. Three studies directly investigated TIVA versus volatile, whereas 12 studies compared general anesthesia to conscious sedation. The total number of subjects was 3015 (conscious sedation: n = 1067; general anesthesia: n = 1948 [TIVA: n = 1212, volatile: n = 736]). No significant differences were identified between TIVA and volatile groups in 90-day neurological outcome (OR = 1.25, 95% confidence interval [CI], 0.81–1.91; P = .31), 90-day mortality (OR = 0.72, 95% CI, 0.42–1.24; P = .24), successful recanalization (OR = 1.33, 95% CI, 0.70–2.52; P = .39), or recanalization time (standardized mean difference = 0.03, 95% CI, –0.35 to 0.41; P = .88). Additionally, no significant differences were identified between the conscious sedation group and the TIVA group in 90-day neurological outcome (OR = 1.14, 95% CI, 0.84–1.53; P = .40), 90-day mortality (OR = 0.87, 95% CI, 0.62–1.23; P = .43), successful recanalization (OR = 0.76, 95% CI, 0.52–1.10; P = .15), or recanalization time (standardized mean difference = –0.18, 95% CI, –0.47 to 0.11; P = .23), and between the conscious sedation group and the volatile group in 90-day neurological outcome (OR = 1.42, 95% CI, 0.92–2.17; P = .11), 90-day mortality (OR = 0.63, 95% CI, 0.36–1.12; P = .11), successful recanalization (OR = 1.01, 95% CI, 0.52–1.94; P = .98), or recanalization time (standardized mean difference = –0.15, 95% CI, –0.52 to 0.23; P = .44).
CONCLUSIONS:
This network meta-analysis showed that the perioperative use of either general anesthesia-based regimen, or sedation, did not significantly impact various endovascular therapy-related outcomes. However, the current work was underpowered to detect differences in anesthetic agents, clinico-demographic characteristics, or procedural factors.
KEY POINTS
Question: What is the effect of total intravenous anesthesia-based general anesthesia as compared to volatile-based general anesthesia on functional outcomes in patients with acute ischemic stroke undergoing endovascular therapy?
Findings: No differences were identified in neurological outcome, mortality, successful recanalization, or recanalization time between the 2 general anesthesia regimens.
Meaning: This systematic review and meta-analysis provides insight toward general anesthesia and sedation options used for endovascular therapy.
