Perioperative stroke after non-cardiac, non-neurological surgery

Abstract

Learning objectivesBy reading this article, you should be able to: Identify patients with risk factors for perioperative stroke. Implement perioperative optimisation strategies for high risk patients. Discuss issues related to postoperative screening and management of stroke. Discuss recent evidence about the frequency and sequelae of covert perioperative stroke.Perioperative stroke is a devastating complication of surgery that is relatively under-recognised and uncharacterised compared with other perioperative complications. Although the reported incidence varies by population studied, approximately 0.1e1.9% of patients having non-cardiac, non-neurological surgery will experience a stroke. 1,2 The consequences of perioperative stroke can be devastating and these patients do poorly, with a rate of disability and mortality higher than after stroke unrelated to surgery. Although perioperative stroke is relatively understudied compared with postoperative complications of similar incidence and severity, recent evidence has provided more insight into how we can prevent, identify and manage this complication. We provide a narrative review of the evidence summarising the definitions, epidemiology, prevention and management of perioperative Clinical scenarioA 75-yr-old man presents for total knee replacement. Further questioning reveals that he suffered an ischaemic stroke 2 months ago, and has mild residual weakness of his left hand. He has a history of atrial fibrillation and takes warfarin. Should you delay his surgery? How should you manage his anticoagulation?

Hypertriglyceridemia is associated with stroke after non-cardiac, non-neurological surgery in the older patients: A nested case-control study

“…However, the 30-day mortality rates in patients who experience postoperative stroke ranged from 21 to 26%, which were 8 times greater than those without postoperative stroke ( Mashour et al, 2011 ; Wang et al, 2019 ; Benesch et al, 2021 ). Meanwhile, patients with postoperative stroke also have longer hospital stay and higher risk of being discharged to long-term care facilities ( Lindberg and Flexman, 2021 ). Notably, perioperative covert stroke was reported to occur in up to 7% of the older patients undergoing non-cardiac, non-neurological surgery ( Mrkobrada et al, 2019 ).…”

An Examination of History for Promoting Diversity in Neuroscience

“…1 ) ( 9 – 11 •). Stroke associated with poor health, perioperative stroke, and trauma potentially affecting both young and older members of our populace is expected to become more prevalent by 2030 ( 12 , 13 •, 14 – 16 ). This is particularly concerning in African American communities where stroke is already more prevalent.…”

Evaluating a Novel EEG-Based Index for Stroke Detection Under Anesthesia During Mechanical Thrombectomy

“…P erioperative acute stroke (AS) is a significant cause of morbidity and mortality, [1][2][3][4] with a prevalence of 0.7 to 1.9% depending on a number of risk factors, 5 and with a higher incidence (3 to 5%) for certain surgeries. 6 Stroke can also occur postoperatively in the intensive care unit, 7 leading to delayed clinical evaluation when patients are intubated, sedated, or sleeping.…”

“…Different technologies have been suggested for the evaluation of neurophysiological function 6 with no consensus on their use for the diagnosis of intraoperative stroke 9 that might lead to earlier intervention and improved treatment. 5,8,9,10 Given the low prevalence of perioperative AS, 11 large patient samples are needed to evaluate potential novel technologies for the identification of intraoperative stroke. Therefore, in this study, we wished to assess the potential utility of a different approach to the early phase of evaluation of a novel marker for identifying stroke during anesthesia.…”

“…Thus, rapid identification of AS during and after anesthesia might lead to effective interventions. Different technologies have been suggested for the evaluation of neurophysiological function 6 with no consensus on their use for the diagnosis of intraoperative stroke 9 that might lead to earlier intervention and improved treatment 5,8,9,10 …”