Blood Pressure Management After Intracerebral and Subarachnoid Hemorrhage: The Knowns and Known Unknowns

Minhas, Jatinder S.; Moullaali, Tom J; Rinkel, Gabriël J.E.; Anderson, Craig S.

doi:10.1161/strokeaha.121.036139

Cited by 34 publications

(24 citation statements)

References 79 publications

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“…The importance of striking a balance between the prevention of rebleeding and the avoidance of secondary cerebral ischemia is highlighted, especially during the initial treatment (Ma and Bebawy, 2022). However, there is disagreement about the target blood pressure threshold (Steiner et al, 2013;Minhas et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Intraoperative arterial pressure and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage after surgical clipping: A retrospective cohort study

Wang

Zhao²,

Li³

et al. 2023

Front. Neurosci.

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BackgroundDelayed cerebral ischemia (DCI) is the major predictor of poor outcomes in patients with aSAH. Previous studies have attempted to assess the relationship between controlling blood pressure and DCI. However, the management of intraoperative blood pressure in reducing the occurrence of DCI still remains inconclusive.MethodsAll patients with aSAH who received general anesthesia for surgical clipping between January 2015 and December 2020 were prospectively reviewed. Patients were divided in the DCI group or the non-DCI group depending on whether DCI occurred or not. Intraoperative arterial pressure was measured every minute and recorded in an electronic anesthesia recording system along with intraoperative medication and other vital signs. The initial neurological function score, aneurysm characteristics, surgical and anesthetic information, and outcomes were compared between the DCI and the non-DCI groups.ResultsAmong 534 patients who were enrolled, a total of 164 (30.71%) patients experienced DCI. The baseline characteristics of patients were similar between the groups. The World Federation of Neurosurgical Societies (WFNS) Scale > 3, age ≥ 70 years, and the modified Fisher Scale > 2 were significantly higher in patients with DCI than those without. Though it was the second derivative of the regression analysis, 105 mmHg was adopted as the threshold for intraoperative hypotension and was not associated with DCI.ConclusionsThe threshold of 105 mmHg was adopted as intraoperative hypotension even though it was the second derivative of the regression analysis and could not be proved to be associated with delayed cerebral ischemia adjusted by the baseline severity of aSAH and age.

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Section: Introductionmentioning

confidence: 99%

Intraoperative arterial pressure and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage after surgical clipping: A retrospective cohort study

Wang

Zhao²,

Li³

et al. 2023

Front. Neurosci.

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“…Further, a recent study also confirmed that the median age of patients was 74 (66-82) years for ischemic stroke, 70 (59-79) years for intracerebral hemorrhage, and 64 (53-75) years for subarachnoid hemorrhage among the 183,080 stroke patients [27]. Thus, younger patients who suspected stroke may have an increased risk of hemorrhagic stroke prehospital, which was associated with the poorer blood pressure control and an increased proportion of subarachnoid hemorrhage [28].…”

Section: Discussionmentioning

confidence: 77%

Development and validation of a clinical nomogram for differentiating hemorrhagic and ischemic stroke prehospital

Pan

et al. 2023

BMC Neurol

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Objectives The early detection and identification of stroke are essential to the prognosis of patients with suspected stroke symptoms out-of-hospital. We aimed to develop a risk prediction model based on the FAST score to identify the different types of strokes early for emergency medical services (EMS). Methods This retrospective observational study enrolled 394 stroke patients at a single center from January 2020 to December 2021. Demographic data, clinical characteristics, and stroke risk factors with patients were collected from the EMS record database. Univariate and multivariate logistic regression analysis was used to identify the independent risk predictors. The nomogram was developed based on the independent predictors, in which the discriminative value and calibration of the nomogram were verified by the receiver operator characteristic (ROC) curve and calibration plots. Results A total of 31.90% (88/276) of patients were diagnosed with hemorrhagic stroke in the training set, while 36.40% (43/118) in the validation set. The nomogram was developed based on the multivariate analysis, including age, systolic blood pressure, hypertension, vomiting, arm weakness, and slurred speech. The area under the curve (AUC) of the ROC with nomogram was 0.796 (95% CI: 0.740–0.852, P < 0.001) and 0.808 (95% CI:0.728–0.887, P < 0.001) in the training set and validation set, respectively. In addition, the AUC with the nomogram was superior to the FAST score in both two sets. The calibration curve showed a good agreement with the nomogram and the decision curves analysis also demonstrated that the nomogram had a wider range of threshold probabilities than the FAST score in the prediction risk of hemorrhagic stroke. Conclusions This novel noninvasive clinical nomogram shows a good performance in differentiating hemorrhagic and ischemic stroke for EMS staff prehospital. Moreover, all of the variables of nomogram are acquired in clinical practice easily and inexpensively out-of-hospital.

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“…The first was on the current evidence, knowledge gaps, and emerging concepts on BP management after SAH and ICH and the second was on BP management in the first 24 hours after ischemic stroke. 56,57 The final one was on optimal hemodynamic parameters for brain-injured patients in the clinical setting. 58 Other interesting reviews include opioid alternatives in spine surgery, the effects of anesthesia on glioma progression and cardiac-cerebral coupling.…”

Section: Narrative Reviews Of Interestmentioning

confidence: 99%

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2022

Nijs

Chhabra

Venkatraghavan

2023

J Neuroanaesth Crit Care

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This review is a synopsis of selected articles from neuroscience, neuroanesthesia, and neurocritical care from the year 2022 (January–November 2022). The journals reviewed include anesthesia journals, critical care medicine journals, neurosurgical journals as well as high-impact medical journals such as the Lancet, Journal of American Medical Association (JAMA), New England Journal of Medicine (NEJM), and Stroke. The summary of important articles will serve to update the knowledge of neuroanesthesiologists and other perioperative physicians who provide care to neurosurgical and neurocritical cases.

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Blood Pressure Management After Intracerebral and Subarachnoid Hemorrhage: The Knowns and Known Unknowns

Cited by 34 publications

References 79 publications

Intraoperative arterial pressure and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage after surgical clipping: A retrospective cohort study

Intraoperative arterial pressure and delayed cerebral ischemia in patients with aneurysmal subarachnoid hemorrhage after surgical clipping: A retrospective cohort study

Development and validation of a clinical nomogram for differentiating hemorrhagic and ischemic stroke prehospital

Year in Review: Synopsis of Selected Articles in Neuroanesthesia and Neurocritical Care from 2022

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