Pathophysiological and clinical considerations in the perioperative care of patients with a previous ischaemic stroke: a multidisciplinary narrative review
posted on 2021-08-18, 09:46authored byJatinder S Minhas, William Rook, Ronney B Panerai, Ryan L Hoiland, Phil N Ainslie, Jonathan P Thompson, Amit K Mistri, Thompson G Robinson
With an ageing population and increasing incidence of cerebrovascular disease, an increasing number of patients presenting for routine and emergency surgery have a prior history of stroke. This presents a challenge for pre-, intra-, and postoperative management as the neurological risk is considerably higher. Evidence is lacking around anaesthetic practice for patients with vascular neurological vulnerability. Through understanding the pathophysiological changes that occur after stroke, insight into the susceptibilities of the cerebral vasculature to intrinsic and extrinsic factors can be developed. Increasing understanding of post-stroke systemic and cerebral haemodynamics has provided improved outcomes from stroke and more robust secondary prevention, although this knowledge has yet to be applied to our delivery of anaesthesia in those with prior stroke. This review describes the key pathophysiological and clinical considerations that inform clinicians providing perioperative care for patients with a prior diagnosis of stroke.
History
Citation
British Journal of Anaesthesia
Volume 124, Issue 2, February 2020, Pages 183-196
Author affiliation
Department of Cardiovascular Sciences, University of Leicester