Effects of intraoperative inhalational versus intravenous anesthesia on perioperative neurological outcomes and long-term prognosis in patients with moyamoya disease undergoing revascularization surgery: a systematic review and meta-analysis

General anesthesia versus non-GA for endovascular thrombectomy of posterior circulation stroke: A five-year retrospective analysis of the impact on patient outcomes.

INTRODUCTION The optimal anesthesia strategy during endovascular thrombectomy (EVT) for posterior circulation acute ischemic stroke (PC-AIS) remains unclear. METHODS We conducted a 5-year retrospective cohort study of consecutive PC-AIS patients treated with EVT and categorized by anesthetic modality: general anesthesia (GA) or non-GA. The primary outcome was functional independence at 90 days, defined as a modified Rankin Scale (mRS) score of 0-2. Secondary outcomes included successful reperfusion (mTICI 2b-3) and 3-month mortality. Multivariable logistic regression was used to adjust for confounding factors. RESULTS Of 132 patients, 55 (41.7%) underwent EVT under GA. Good functional outcome was achieved in 61.5% of GA patients versus 47.9% of non-GA patients. However, after adjustment, GA was not independently associated with functional independence (adjusted OR 0.72, 95% CI 0.22-2.31;p =  0.571). Reperfusion rates were similar for both groups (successful reperfusion: GA 84.1% vs. non-GA 81.7%, p =  0.458) and mortality at 3 months did not differ significantly (GA: 18.2% vs. non-GA: 20.8%; adjusted OR 2.41, 95% CI 0.78-7.47; p =  0.127). DISCUSSION There is no significant difference in outcomes between patients with PC-AIS undergoing EVT with GA versus non-GA. These findings align with recent evidence, suggesting comparable functional, angiographic, and survival outcomes across anesthetic strategies, though limitations related to retrospective design and practice variability remain. CONCLUSION Anesthetic modality (GA vs. non-GA) does not significantly affect 3-month functional outcomes, successful reperfusion, or mortality during EVT for PC-AIS, supporting an individualized, patient- and procedure-based approach.

Current evidence of multimodal anesthesia on postoperative outcomes: A systematic review and Meta-analysis.

BACKGROUND Multimodal anesthesia (MMA) is widely used to reduce opioid use and improve postoperative recovery. However, evidence for bundled MMA regimens-defined as opioids plus ≥2 adjunct analgesic modalities-has not been systematically synthesized across patient-centered outcomes. METHODS We performed a systematic review and meta-analysis of randomized controlled trials comparing MMA (opioids plus ≥2 adjuncts, including regional techniques and/or systemic agents such as dexmedetomidine, ketamine, intravenous lidocaine, clonidine, or magnesium) with opioid-based general anesthesia in adults undergoing elective surgery. MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library were searched to 28 October 2025. Primary outcomes were postoperative pain, PONV, QoR-15, and pulmonary complications. Secondary outcomes included opioid consumption in Morphine Milligram Equivalent (MME) and PACU length of stay. Risk of bias was assessed with RoB 2 and certainty with GRADE. Registered in PROSPERO (CRD42024470056). RESULTS Twenty-one RCTs (n = 1828) were included. At 24 h, no clear effect of MMA on pain intensity was observed (10 trials, n = 785; MD -0.6, 95% CI -1.5 to 0.2; very low certainty). MMA reduced PONV incidence (4 trials, n = 352; RR 0.59, 95% CI 0.44 to 0.77; low certainty). For secondary outcomes, MMA reduced opioid consumption (10 trials, n = 915; MD -7.0 mg MME, 95% CI -12.8 to -1.3; moderate certainty), with the opioid-sparing effect persisting at 48 h (MD -14.0 mg MME) and study end (MD -16.0 mg). Data for QoR-15, PACU stay, and pulmonary complications were insufficient for pooling. CONCLUSIONS MMA shows no clear effect on postoperative pain at 24 h but reduces PONV incidence and opioid consumption. Evidence certainty ranges from moderate to very low. Larger, standardized trials are needed to define optimal MMA regimens and patient selection.

The impact of different intervention methods (anesthetic adjuvant drugs, anesthetic techniques, and non-pharmacological interventions) on postoperative cognitive function in patients undergoing cardiac surgery: a systematic review and Bayesian network meta-analysis

Objective Postoperative cognitive dysfunction (POCD) is a frequent complication after cardiac surgery, with inconsistent evidence regarding preventive strategies. This network meta-analysis aims to evaluate and compare multiple interventions to establish an evidence-based framework for optimizing clinical management. Methods A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted for randomized controlled trials (RCTs) involving patients undergoing cardiac surgery. The study, adhering to PRISMA-NMA guidelines, included various interventions such as anesthetic agents, adjunctive drugs, and cognitive training. Methodological quality was assessed using the Cochrane Risk of Bias tool. We performed a Bayesian network meta-analysis. Rankings were interpreted according to the prespecified favorable outcome direction; therefore, lower SUCRA values denoted greater preventive effectiveness. Results The analysis included 46 RCTs, encompassing 9,928 patients and 20 different intervention strategies. Most studies demonstrated a low risk of bias. Because POD and POCD were adverse-event incidence outcomes and MMSE change was coded so that smaller unfavorable postoperative decline represented benefit, lower SUCRA values were interpreted as indicating greater intervention effectiveness. Intranasal insulin, gastrodin, and cognitive training showed the lowest SUCRA values for POD-related outcomes. Gastrodin, esketamine, and dexmedetomidine showed the lowest SUCRA values for POCD-related outcomes. MMSE-change rankings were interpreted cautiously because they were based on fewer studies and were sensitive to the coding direction of change scores. Conclusion This network meta-analysis suggests that intranasal insulin, gastrodin, cognitive training, esketamine, and dexmedetomidine may reduce POD or POCD after cardiac surgery. However, the comparative rankings are uncertain for interventions supported by few studies, and the MMSE-change findings remain exploratory. Further high-quality RCTs are required to confirm these results. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251128365, identifier (CRD420251128365).

Perioperative intravenous lidocaine for gastrointestinal recovery and pain control in elective colorectal surgery: a systematic review and updated meta-analysis of randomized controlled trials.

CHOICE OF ANESTHESIOLOGICAL CARE (GENERAL OR REGIONAL ANESTHESIA) FOR CAROTID ENDARTERECTOMY

Carotid endarterectomy (CEAE) is the "gold standard" for stroke prevention in patients with hemodynamically significant carotid artery stenosis. The choice of anesthesia method — general (OA) or regional (RA) — remains a matter of debate, as it affects the risk of perioperative complications. This article analyzed 78 sources, including randomized controlled trials, prospective and retrospective cohorts, systematic reviews, and meta-analyses published through 2026. There was no statistically significant difference in the incidence of perioperative stroke between OA and RA. However, RA was associated with a significant reduction in the risk of myocardial infarction, especially in patients with heart failure. RA also correlated with shorter duration of surgery and hospitalization, but with more frequent hemodynamic fluctuations. The effectiveness of neuromonitoring (multimodal in OA and clinico-instrumental in RA) was a key factor determining neurological safety. Moderate hypothermia has shown potential in reducing postoperative cognitive impairment. Thus, the choice between OA and RA in CEAE should be personalized, based on the patient's dominant risk profile.

Effect of general anesthesia on postoperative outcomes of transcatheter aortic valve implantation in patients: a systematic review and meta-analysis

Objective The optimal mode of anesthesia for patients undergoing transcatheter aortic valve implantation (TAVI) surgery has been controversial recently, especially with the popularization of TAVI in young and low-risk patients and reduced dependence on transesophageal echocardiography (TEE). Beyond general anesthesia (GA), there are more than one type of anesthetic methods such as regional anesthesia (RA), local anesthesia (LA), monitored anesthesia care (MAC), deep sedation (DS), conscious sedation (CS) et al. used on TAVI. The aim of this systematic review and meta-analysis was to evaluate the effects of general anesthesia on the prognosis of patients undergoing TAVI. Methods The Cochrane Library, PubMed, Embase, and Medline databases were searched from their inception to May 2025. Literature was selected according to the inclusion and exclusion criteria, and the meta-analysis was completed using RevMan 5.3. Results A total of eligible 38 literatures were enrolled, including 23,848 patients. The results of the meta-analysis showed that compared with the non-GA groups, the in-hospital mortality (RR = 1.99, 95%CI, 1.19–3.30, P = 0.008), incidence of postoperative pneumonia (RR = 2.39, 95%CI, 1.43–4.00, P = 0.0009), procedure time (MD = 20.22, 95%CI, 15.37–25.07, P < 0.00001), length of hospital stay (MD = 1.43, 95%CI, 1.10–1.76, P < 0.00001), and ICU stay (SMD = 1.91, 95%CI, 1.40–2.42, P < 0.00001) were all increased in the GA group. There were no significant differences between the groups in 30-day mortality (RR = 1.19, 95%CI, 0.97–1.47, P = 0.09), postoperative acute kidney injury (RR = 1.16, 95%CI, 0.90–1.50, P = 0.26), postoperative stroke (RR = 0.99, 95%CI, 0.80–1.22, P = 0.90), postoperative vascular complication (RR = 1.10, 95%CI, 0.92–1.33, P = 0.30), and postoperative myocardial infarction (RR = 1.12, 95%CI, 0.72–1.73, P = 0.61). Conclusion GA not only increases in-hospital mortality and the incidence of postoperative pulmonary infections in patients undergoing TAVI but also prolongs the length of hospitalization and ICU stay. However, GA did not increase the incidence of postoperative acute kidney injury, stroke, myocardial infarction, or vascular complications, nor did it increase the 30-day postoperative mortality rate and long-term quality of life in patients. The choice of anesthesia for TAVI should be evaluated according to the patient's condition and surgical approaches to minimize adverse complications and mortality. Further RCTs are required to verify the most likely anesthetic choices for TAVI.