Deans' stroke musings: Conscious sedation no better than general anesthesia in post-stroke endovascular treatment

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, September 29, 2022

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

Both primary and secondary endpoint measures are wrong. The only measurement that survivors care about is 100% recovery. Until we get that mindset installed in stroke researchers we will NEVER SOLVE STROKE.

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.

patient recieving anesthesia — Source: Adobe Stock.

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.”