Covert stroke after non-cardiac surgery: a prospective cohort study

Abstract

NCT01369537.

Cerebral blood flow and its autoregulation - when will there be some light in the black box?

“…Moreover, brain magnetic resonance imaging studies suggest that 1 in 10 elderly patients has a (subclinical) covert perioperative stroke. 2 The World Health Organization considers that because of an ageing population, by 2030 chronic diseases will affect the lives of nearly 52 million inhabitants in the European region. More than 80% of people aged above 65 yr will suffer from chronic diseases, especially of the cardiovascular and neurovascular systems.…”

“…1 From a purely practical perspective, a non-invasive metric that tracks sensory awareness and is robust to the combination of anaesthetic drugs and patient factors would be a welcome addition to the anaesthetist's perioperative tool kit. 2 From a theoretical perspective, such a metric would prove invaluable for endeavours to understand the neural basis of consciousness, and in particular, sensory awareness. 2 The contribution by Plourde and Arseneau 3 in this month's British Journal of Anaesthesia provides evidence towards that end.…”

“…2 From a theoretical perspective, such a metric would prove invaluable for endeavours to understand the neural basis of consciousness, and in particular, sensory awareness. 2 The contribution by Plourde and Arseneau 3 in this month's British Journal of Anaesthesia provides evidence towards that end. The authors report that the a 2 -agonist dexmedetomidine attenuates high-frequency oscillations in the cortex and thalamus at doses that induce loss of the righting reflex.…”

Association between perioperative hyperoxia and cerebrovascular complications after laparotomy—A post‐hoc follow‐up study

“…Such a difference is furthermore not clinically relevant, but our analyses cannot exclude a larger effect of hyperoxia on cerebrovascular complications. It is furthermore likely that only a minor subgroup of patients in the PROXI trial had a primary cerebral injury or covert stroke during the exposure to study intervention, and that reduce our power to detect a potential association between perioperative hyperoxia and primary or secondary cerebral injury.…”

Cerebral oxygenation and vascular resistance changes during cardiopulmonary bypass – where is the proof? A reply

“…Finally, evidence is accumulating that cerebral perfusion during general anaesthesia could be compromised more than previously thought. Magnetic resonance imaging studies have shown the incidence of covert stroke during anaesthesia may be as high as 10% in patients over 65 years of age . Since vasopressors like phenylephrine are widely used, and their exact effects on the cerebral vasculature during anaesthesia remain uncertain, we suggest that future research is needed to quantify the response of cerebral haemodynamics to commonly used anaesthetic and vasopressor drugs.…”