Systematic ReviewResearchWorkflow

General anesthesia during stroke thrombectomy improved reperfusion but increased intraoperative hypotension

Neurology (PubMed)Jul 16, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A Bayesian meta-analysis of 10 randomized trials involving 1,601 adults found higher successful reperfusion with general anesthesia during stroke thrombectomy, alongside substantially more intraoperative hypotension and no clear mortality difference.

What NurseJet pulled from the source

This systematic review synthesized 10 randomized trials involving 1,601 adults undergoing endovascular thrombectomy for acute ischemic stroke. General anesthesia was associated with higher successful reperfusion (OR 1.73, 95% credible interval 1.23 to 2.43) and a 94.2% posterior probability of better 90-day functional independence, although that functional-outcome credible interval included no difference. Mortality and symptomatic intracranial hemorrhage did not differ substantially. Intraoperative hypotension was more frequent with general anesthesia (OR 4.28, 95% credible interval 2.35 to 7.86), emphasizing the importance of hemodynamic management.

Why this matters for nurses

Stroke and critical-care nurses coordinate rapid thrombectomy workflows, monitor hemodynamics, and reassess neurologic status before and after reperfusion. The findings suggest a potential procedural benefit while highlighting hypotension as an important competing risk.

Bedside takeaway

General anesthesia improved reperfusion during stroke thrombectomy but increased hypotension, so time-critical workflow and hemodynamic surveillance both matter.

How This Applies in Practice

Use this when: Supporting an adult undergoing endovascular thrombectomy through an approved acute-stroke pathway.

On your shift

Complete time-sensitive preparation and handoff steps without delaying the stroke and anesthesia teams' selected strategy.
Trend blood pressure and neurologic status at the pathway's required intervals and promptly escalate hypotension or deterioration.

Keep in mind: The review does not establish one anesthesia strategy for every patient. Follow the stroke pathway, facility policy, and patient-specific anesthesia and provider orders.

Explain this for my unit

Key takeaways

The Bayesian synthesis included 10 randomized trials and 1,601 adults undergoing stroke thrombectomy.
Successful reperfusion was higher with general anesthesia than with non-general-anesthesia strategies.
The functional-independence estimate favored general anesthesia, but its 95% credible interval included no difference.
Intraoperative hypotension was substantially more frequent with general anesthesia, while mortality did not differ clearly.

Practice implications

Do not treat the anesthesia strategy as a bedside nursing choice. During the approved thrombectomy pathway, maintain time-sensitive preparation, closely trend blood pressure and neurologic status, and promptly communicate hypotension or deterioration to the stroke and anesthesia teams.

Limitations & cautions

The trials were open label and used heterogeneous non-general-anesthesia comparators. The Bayesian functional-independence estimate favored general anesthesia, but its credible interval included no difference, and pneumonia also trended higher without a conclusive credible interval. Confirmatory evidence is still needed.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

Public citations are filtered to exact credible source pages. Homepage-only or invalid links stay in admin review and are not shown here.

Neurology (PubMed)

Neurology (PubMed). General Anesthesia Versus Non-GA in Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Bayesian Meta-Analysis of RCTs.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42462185/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

Related briefs

More updates for this clinical area

Back to Discover

Enfermeria intensiva (PubMed)Jul 3, 2026Research ArticlePractice applicable

In an open-label randomized trial that analyzed 98 post-cardiac-surgery patients, virtual-reality distraction did not significantly reduce pain or state anxiety during chest-drain removal versus usual care, although satisfaction was high.

Telemetry ICUAI summaryReview source

Research ArticleResearchWorkflowPractice applicableAI summary · original source linked below

This single-center randomized trial enrolled 101 spontaneously breathing, communicative patients in a cardiac surgery unit and analyzed 98. Patients underwent chest-drain removal with virtual-reality distraction or usual care, with pain and state anxiety assessed at baseline and after the procedure. The time-by-treatment interaction was not significant for pain (mean difference 0.16, 95% CI -0.70 to 1.03; p=0.71) or state anxiety (mean difference -1.83, 95% CI -4.50 to 0.88; p=0.18). Patients rated the virtual-reality experience highly, but satisfaction did not translate into measured analgesic or anxiety benefit.

Key takeaways

The open-label trial enrolled 101 post-cardiac-surgery patients and analyzed 98.
Virtual reality did not significantly reduce pain during chest-drain removal compared with usual care.
State-anxiety differences were also not statistically significant.
Mean satisfaction with the virtual-reality experience was high at 8.3 out of 10.

Why this matters on shift

Cardiac and critical-care nurses prepare patients for chest-drain removal and support procedural comfort. This trial matters because it found that a well-liked distraction tool did not improve the outcomes it was intended to change.

Bedside takeaway

Be aware that virtual reality was well liked but did not significantly reduce pain or anxiety during chest-drain removal in this cardiac-surgery trial.

Nursing implications

Do not assume that high patient satisfaction with virtual reality means it reduces procedural pain or anxiety. Continue facility-approved pain assessment and comfort measures for chest-drain removal, and evaluate any new distraction tool against clinical outcomes as well as acceptability.

Limitations & cautions

This was an open-label, single-center study limited to spontaneously breathing patients who could communicate. The analysis included 98 patients, and the study does not establish whether different virtual-reality content, patient selection, or use alongside other interventions would change outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Enfermeria intensiva (PubMed). Virtual reality to reduce pain and anxiety during the removal of chest drains after cardiac surgery: A randomized controlled trial.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

The Cochrane database of systematic reviews (PubMed)Jul 14, 2026Systematic ReviewPractice applicable

A Cochrane review of nine randomized trials involving 4,381 adults found that intensive systolic targets below 160 mmHg after ischemic-stroke reperfusion produced no clinically meaningful functional or hemorrhage benefit and probably increased all-cause mortality.

Emergency ICUAI summaryReview source

Systematic ReviewResearchWorkflowPractice applicableAI summary · original source linked below

This Cochrane review compared intensive systolic blood-pressure targets below 160 mmHg with conventional targets, generally below 180 mmHg, after thrombolysis or endovascular thrombectomy for ischemic stroke. Nine randomized trials included 4,381 participants. Intensive management produced little to no clinically meaningful difference in functional outcomes and did not change the risk of any intracranial hemorrhage (RR 0.99, 95% CI 0.87 to 1.14). It probably increased all-cause mortality (RR 1.19, 95% CI 1.08 to 1.32) and probably reduced the proportion of participants with favorable neurologic status, although the estimate included the possibility of little difference. The review does not support assuming that a lower post-reperfusion target is safer or more effective for every patient.

Key takeaways

The review included nine randomized trials and 4,381 adults after thrombolysis or endovascular thrombectomy.
Intensive systolic targets below 160 mmHg did not produce a clinically meaningful functional benefit.
Any intracranial hemorrhage was similar with intensive and conventional management.
Intensive management probably increased all-cause mortality, with a pooled risk ratio of 1.19.

Why this matters on shift

Stroke and critical-care nurses repeatedly measure blood pressure, assess neurologic status, administer ordered antihypertensives, and escalate deviations after reperfusion. This review matters because it challenges the intuitive assumption that pushing systolic pressure lower than conventional targets necessarily improves recovery.

Bedside takeaway

Be aware that intensive systolic targets below 160 mmHg after stroke reperfusion probably increased mortality without meaningful functional or hemorrhage benefit.

Nursing implications

Use the prescribed post-reperfusion target and the facility's stroke protocol rather than treating a lower systolic pressure as automatically better. Pair blood-pressure surveillance with neurologic reassessment and promptly communicate out-of-range values or clinical deterioration to the stroke team.

Limitations & cautions

The intensive targets varied across trials, including thresholds below 120, 140, and 160 mmHg; seven studies involved thrombectomy and two involved thrombolysis. Studies were mainly from upper-middle- and high-income countries, and certainty ranged from high to very low across outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

The Cochrane database of systematic reviews (PubMed). Blood pressure management in reperfused ischemic stroke.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Hospital Pediatrics (PubMed)Jul 14, 2026Systematic ReviewPractice applicable

A systematic review of 23 pediatric inpatient studies found that most alarm-reduction projects lowered monitor-alarm frequency and every study measuring nonactionable alarms reported a decrease, but study heterogeneity prevented comparison of individual strategies and safety balancing measures were inconsistent.

Peds ICUAI summaryReview source

Systematic ReviewResearchQuality ImprovementWorkflowPractice applicableAI summary · original source linked below

This systematic review examined interventions intended to reduce pulse-oximeter and cardiorespiratory-monitor alarms in pediatric inpatient care. The 23 included studies comprised 12 NICU studies, two PICU studies, eight medical-surgical studies, and one spanning PICU and medical-surgical care; 16 were quality-improvement studies, five were nonrandomized, and two were randomized trials. Common approaches included staff education, universal or patient-specific parameter changes, longer alarm delays, and standardized communication about monitoring plans. Most studies reported fewer alarms, and every study that measured nonactionable alarms reported a decrease. However, heterogeneity prevented comparison of individual interventions, balancing measures were inconsistently reported, and the review found no standardized method for synthesizing quality-improvement studies.

Key takeaways

The review included 23 studies across neonatal, pediatric intensive-care, and pediatric medical-surgical settings.
Sixteen studies were quality-improvement projects, five were nonrandomized, and only two were randomized trials.
Most studies reported lower alarm frequency, and all studies measuring nonactionable alarms reported decreases.
The review could not compare individual interventions because of heterogeneity, and safety balancing measures were reported inconsistently.

Why this matters on shift

Pediatric nurses are exposed to repeated monitor alarms and are central to monitoring-plan communication and response. This review matters because it identifies recurring alarm-reduction approaches while warning that lower alarm counts alone do not establish that a change is safer.

Bedside takeaway

Worth knowing that pediatric alarm-reduction projects usually lowered alarm counts, but heterogeneous methods and inconsistent safety balancing measures prevent naming one best approach.

Nursing implications

Pediatric units can use the review to structure approved alarm-reduction work around clear monitoring plans, staff education, nonactionable-alarm measurement, and balancing outcomes. Alarm limits or delays should not be changed outside approved orders and unit protocols, and the review did not identify one superior approach.

Limitations & cautions

The evidence was dominated by heterogeneous quality-improvement and nonrandomized studies, with only two randomized trials. Intervention effects could not be compared, balancing measures were inconsistent, no pooled effect estimate was available, and methods for systematically reviewing quality-improvement studies are not standardized.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Hospital Pediatrics (PubMed). Interventions to Reduce Monitor Alarms Across Pediatric Inpatient Settings: A Systematic Review.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Virtual reality did not reduce pain or anxiety during chest-drain removal after cardiac surgery

Intensive blood-pressure lowering after stroke reperfusion probably increased mortality without meaningful functional benefit

Pediatric monitor-alarm projects usually reduced alarm burden, but safety balancing measures were inconsistent