Newly Published
Perioperative Medicine  |   February 2017
Anesthetic Neuroprotection in Experimental Stroke in Rodents: A Systematic Review and Meta-analysis
Author Notes
  • From the Departments of Anesthesiology and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (D.P.A., A.M.W., J.J.M., R.M.A.); and CAMARADES, Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, United Kingdom (S.K.M.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Presented, in part, at the Canadian Anesthesiologists Annual Meeting, Vancouver, Canada, June 24–27, 2016.
    Presented, in part, at the Canadian Anesthesiologists Annual Meeting, Vancouver, Canada, June 24–27, 2016.×
  • Submitted for publication August 3, 2016. Accepted for publication December 15, 2016.
    Submitted for publication August 3, 2016. Accepted for publication December 15, 2016.×
  • Acknowledgments: The authors wish to thank the following individuals from the University of Calgary, Calgary, Alberta, Canada: Helen Lee Robertson, M.L.I.S., Health Sciences Librarian; from the Department of Anesthesia: J. Mikhayel, M.D., and C. Applewhaite, M.D., for their assistance in data extraction; B. Wang, M.D., and J. M. Davies, M.D., for translation of Chinese articles and review of the article, respectively.
    Acknowledgments: The authors wish to thank the following individuals from the University of Calgary, Calgary, Alberta, Canada: Helen Lee Robertson, M.L.I.S., Health Sciences Librarian; from the Department of Anesthesia: J. Mikhayel, M.D., and C. Applewhaite, M.D., for their assistance in data extraction; B. Wang, M.D., and J. M. Davies, M.D., for translation of Chinese articles and review of the article, respectively.×
  • Research Support: Supported in part by the U.K. National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) infrastructure award: ivSyRMAF—the CAMARADES-NC3Rs in vivo systematic review and meta-analysis facility (NC/L000970/1), Edinburgh, United Kingdom (to Dr. McCann). Received partial salary support during the project from the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (to Dr. Archer, Dr. Walker, Dr. Moser, and Dr. Appireddy). This article does not contain any studies with human participants or animals performed by any of the authors.
    Research Support: Supported in part by the U.K. National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) infrastructure award: ivSyRMAF—the CAMARADES-NC3Rs in vivo systematic review and meta-analysis facility (NC/L000970/1), Edinburgh, United Kingdom (to Dr. McCann). Received partial salary support during the project from the Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada (to Dr. Archer, Dr. Walker, Dr. Moser, and Dr. Appireddy). This article does not contain any studies with human participants or animals performed by any of the authors.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Archer: Department of Anesthesia, Cumming School of Medicine, University of Calgary, 1403 29th St. N.W. Calgary, Alberta, Canada T2N 2T9. darcher@ucalgary.ca. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Central and Peripheral Nervous Systems
Perioperative Medicine   |   February 2017
Anesthetic Neuroprotection in Experimental Stroke in Rodents: A Systematic Review and Meta-analysis
Anesthesiology Newly Published on February 16, 2017. doi:10.1097/ALN.0000000000001534
Anesthesiology Newly Published on February 16, 2017. doi:10.1097/ALN.0000000000001534
Abstract

Background: Patients undergoing endovascular therapy for acute ischemic stroke may require general anesthesia to undergo the procedure. At present, there is little clinical evidence to guide the choice of anesthetic in this acute setting. The clinical implications of experimental studies demonstrating anesthetic neuroprotection are poorly understood. Here, the authors evaluated the impact of anesthetic treatment on neurologic outcome in experimental stroke.

Methods: Controlled studies of anesthetics in stroke using the filament occlusion model were identified in electronic databases up to December 15, 2015. The primary outcome measures, infarct volume, and neurologic deficit score were used to calculate the normalized mean difference for each comparison. Meta-analysis of normalized mean difference values provided estimates of neuroprotection and contributions of predefined factors: study quality, the timing of treatment, and the duration of ischemia.

Results: In 80 retrieved publications anesthetic treatment reduced neurologic injury by 28% (95% CI, 24 to 32%; P < 0.0001). Internal validity was high: publication bias enhanced the effect size by 4% or less, effect size increased with study quality (P = 0.0004), and approximately 70% of studies were adequately powered. Apart from study quality, no predefined factor influenced neuroprotection. Neuroprotection failed in animals with comorbidities. Neuroprotection by anesthetics was associated with prosurvival mechanisms.

Conclusions: Anesthetic neuroprotection is a robust finding in studies using the filament occlusion model of ischemic stroke and should be assumed to influence outcomes in studies using this model. Neuroprotection failed in female animals and animals with comorbidities, suggesting that the results in young male animals may not reflect human stroke.