Perioperative Stroke in the Brain and Spinal Cord Following an Induced Hypotension

Kim, Joong‐Seok; Ko, Seok Beum; Shin, Hye Eun; Han, Si Ryung; Lee, Kwang Soo

doi:10.3349/ymj.2003.44.1.143

Cited by 14 publications

(5 citation statements)

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“…The thoracic region has the largest spacing between radicular arteries in comparison to other spinal segments 10. A watershed zone of increased ischemic vulnerability is located at the interface of the anterior and posterior spinal artery territories, described by many authorities to be at the level of T4 4–6,10. The extent of this patient’s lesion suggests a particularly large area of ischemic vulnerability in the distribution of the anterior spinal artery.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Infarction with Multiple Etiologic Factors

Millichap

Leacock

2007

J GEN INTERN MED

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Spinal cord infarction is uncommon and usually presents with sudden onset of paralysis and sensory disturbances. A variety of causes are described, but rarely with multiple factors involved. We report a case of a 63-year-old man with a history of diabetes mellitus, hypertension, and osteoarthritis who presented with acute onset of chest pain, numbness, and weakness associated with episodic hypotension. He had incomplete tetraplegia and was areflexic without spasticity. Pain and temperature sensations were impaired below the C7 dermatome and absent below the T4 dermatome bilaterally. Proprioception and vibration sensations were diminished on the right below the C6 dermatome. Magnetic resonance imaging showed spinal cord infarction affecting C6-T3 segments, and severe cervical and lumbar spine degenerative changes. This case illustrates an unusual presenting symptom of spinal infarction, the need to identify multiple risk factors for spinal cord infarction, and the importance of optimal preventive therapy in patients at risk.KEY WORDS: spinal cord infarction; anterior spinal artery; preventive medicine.

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Infarction with Multiple Etiologic Factors

Millichap

Leacock

2007

J GEN INTERN MED

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“…However, deliberate hypotension has a potential risk of multiple complications. Even within “a safe range of hypotension,” brain damage, stroke, and death may still occur [9]. It is reported in the early 1950s that mortality associated with deliberate hypotension is about 0.22% to 0.34%, and nonfatal complications mainly referred to cerebral, coronary, and renal circulations occur 908 times (about 2.6% to 3.3%) [10].…”

Section: Introductionmentioning

confidence: 99%

Is deliberate hypotension a safe technique for orthopedic surgery?: a systematic review and meta-analysis of parallel randomized controlled trials

Jiang

Zhou

et al. 2019

J Orthop Surg Res

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BackgroundDeliberate hypotension has been shown to reduce the intraoperative bleeding and the need for allogeneic blood transfusion, and improve the surgical field, but there is still controversy on its clinical safety. This systematic review was designed to assess the safety and benefits of deliberate hypotension for orthopedic surgery.MethodsThe review met the requirements of the PRISMA guidelines. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, ISI Web of Science, ScienceDirect, and four Chinese databases (China National Knowledge Infrastructure, Wanfang, vip citation database, and updated version of China Biology Medicine disc from January 1, 2000 to January 1, 2019) were searched. All parallel randomized controlled trials comparing the effects of using deliberate hypotension with not using deliberate hypotension on clinical outcomes of patients undergoing orthopedic surgery were selected. The primary outcome was overall mortality. The secondary outcomes were the intraoperative blood loss, blood transfusion volume, and serious adverse postoperative events.ResultsA total of 30 studies with 36 comparisons (1454 participants) were included in meta-analysis. Two studies with 120 participants reported overall mortality and the result was zero (low-quality evidence). The use of deliberate hypotension reduced the intraoperative blood loss (mean difference, − 376.7; 95% CI − 428.1 to − 325.3; I2 = 94%; 29 studies, 36 comparisons, and 1398 participants; low-quality evidence) and blood transfusion volume (mean difference, − 242.5; 95% CI − 302.5 to − 182.6; I2 = 95%; 13 studies, 14 comparisons, and 544 participants; low-quality evidence). Six studies with 286 participants reported the occurrence of serious adverse postoperative events and the result was zero (low-quality evidence). Subgroup analyses according to age groups, controlled mean artery pressure levels, types of orthopedic surgeries, different combinations of other blood conservative method, and hypotensive methods mostly did not explain heterogeneity; significant differences were identified in almost all subgroups.ConclusionsBased on the available evidence, it is still unclear whether or not deliberate hypotension is a safe technique for orthopedic surgery due to limited studies with very small sample size, though it may decrease the intraoperative blood loss and blood transfusion volume irrespective of age groups, controlled mean artery pressure levels, types of surgeries, hypotensive methods, or different combinations of other blood conservation strategies.Trial registrationPROSPERO CRD42016045480.

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Section: Introductionmentioning

confidence: 99%

“…Acknowledging that excessive bleeding may impair surgery, extreme hypotension may in turn risk organ hypoperfusion and subsequent ischemic injury . Since the inception of hypotensive anesthesia, a number of authors have reported neurological injury attributable to inadequate cerebral perfusion . Conversely, current literature also reports no short‐ and/or long‐term adverse effects on cerebral, hepatic, and renal function with this technique …”

Section: Introductionmentioning

confidence: 99%

“…1,[20][21][22][23][24] Since the inception of hypotensive anesthesia, a number of authors have reported neurological injury attributable to inadequate cerebral perfusion. 21,23,24 Conversely, current literature also reports no short-and/or long-term adverse effects on cerebral, hepatic, and renal function with this technique. 20,[25][26][27][28][29] Studies evaluating the effect of hypotensive anesthesia on the quality of the surgical field have produced similarly conflicting results, possibly due to heterogeneity in patient attributes, surgical procedures, and methodological disparities.…”

Section: Introductionmentioning

confidence: 99%

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