Hu 2020.

Study characteristics
Methods	Setting: single‐centre, China Design: RCT, 2 arms, parallel assignment, single‐blind Start date: February 2017 Completion date: 30 March 2021
Participants	139 men and women randomised: experimental (GA) = 72, comparator (monitored care anaesthesia (MAC)) = 67; 0 lost to follow‐up Mean age: 72 years Gender (men/women): 72/67 Mean NIHSS and mean ASPECTS not reported 2 (2.9%) participants converted from MAC to GA Participants received IV r‐tPA before EVT (not reported) Diagnostic criteria: AIS with LVO in posterior cerebral circulation (vertebrobasilar system) Inclusion criteria Aged ≥ 18 years Treated with EVT within 6 hours after symptoms onset NIHSS ≥ 4 at admission and premorbid mRS scores < 2 Diagnosed with acute posterior circulation stroke caused by vertebrobasilar occlusion verified by CTA, MRA, DSA  Exclusion criteria Increased risk of bleeding, including platelet count < 100 × 109/L, and history of surgery and substantive organ biopsy within 1 month Life expectancy < 90 days Contraindications for EVT, including arteriovenous malformation or concomitant aneurysm Incomplete information or the follow‐up was lost Intubated at presentation or with a premorbid mRS score > 2 (score range: 0–6, with a lower score indicating independent living) as well as those who had a GCS score < 9 (score range: 3–15, with a lower score indicating lower levels of consciousness)
Interventions	Experimental: GA Suxamethonium bolus 0.5–1 mg/kg (Carbomer Inc., USA), alfentanil bolus 0.02–0.03 mg/kg (Nhwa Pharmaceutical Co., Ltd, China), and propofol bolus 1–5 mg/kg followed by 2–10 mg/kg/hour (EMMX Biotechnology LLC, USA). Endotracheal intubation was followed by mechanical ventilation. Anaesthesia was maintained with propofol 2–10 mg/kg/hour and remifentanil 0.2–1 μg/kg/minute (National Pharmaceutical Industry Co. Ltd., China). Comparator: MAC Fentanyl bolus 25–50 μg (Nhwa Pharmaceutical Co., Ltd, China), repeated as necessary. A propofol infusion of 1–4 mg/kg/hour was initiated and adjusted as required. The participant's sedation was controlled to a Ramsay sedation score of 4 (participant asleep, showed brisk responses to light glabellar tap or loud auditory stimulus) or 5 (participant asleep, showed sluggish response to light glabellar tap or loud auditory stimulus) Excluded medications: not reported
Outcomes	Primary outcome (collected): not reported Primary outcome (collected) Neurological outcome is measured as mRS, 90‐day poststroke Secondary outcomes (collected): not reported Secondary outcomes (collected) Infarct volume and related complications. Cerebral infarct volume calculated using Pullicino formula (length × width × layer number/2) based on the cranial CT or MRI scan within 48 hours after AIS 90‐day mortality  Vessel injury Any parenchymal haematoma according to the European Cooperative Acute Stroke Study
Notes	Conflicts of interest: (quote) "none". Funding: (quote) "This work was supported by the Guangzhou Science and Technology Project (201904010‐389) and National Natural Science Foundation of China (62076253)". Protocol available: not reported.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: no information on random sequence generation.
Allocation concealment (selection bias)	Unclear risk	Quote: "The patients were randomized into GA group and MAC group (about 1:1 ratio)". Comment: not reported if sealed non‐transparent envelopes were used.
Blinding of participants and personnel (performance bias)	High risk	Not described, but due to the nature of the interventions, we assumed that blinding of personnel was not possible.
Blinding of outcome assessment (detection bias)	Low risk	Quote: "blinded end point cohort study, the primary outcome of mRS at 90 days (80–100 days)".
Incomplete outcome data (attrition bias)	Low risk	0 losses. Crossover in 2 (2.9%) participants who were converted from MAC to GA.
Selective reporting (reporting bias)	Unclear risk	Comment: we did not find the study protocol to analyse.
Other bias	Unclear risk	Comment: we did not find the study protocol to analyse.