BJA_Stroke_R3_Clean_Final.docx (92.81 kB)
Pathophysiological and clinical considerations in the perioperative care of patients with a previous ischaemic stroke: a multidisciplinary narrative review
journal contribution
posted on 2021-08-18, 09:46 authored by Jatinder S Minhas, William Rook, Ronney B Panerai, Ryan L Hoiland, Phil N Ainslie, Jonathan P Thompson, Amit K Mistri, Thompson G RobinsonWith 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 183-196Author affiliation
Department of Cardiovascular Sciences, University of LeicesterVersion
- AM (Accepted Manuscript)
Published in
British Journal of AnaesthesiaVolume
124Issue
2Pagination
183 - 196Publisher
Elsevierissn
0007-0912eissn
1471-6771Acceptance date
2019-10-18Copyright date
2019Available date
2021-08-18Publisher DOI
Spatial coverage
EnglandLanguage
EnglishUsage metrics
Categories
Keywords
Science & TechnologyLife Sciences & BiomedicineAnesthesiologyacute ischaemic strokeanaesthesiablood pressurecerebral perfusionendovascular therapyhaemodynamicspreventionthrombolysisCEREBRAL-BLOOD-FLOWCRITICAL CLOSING PRESSURECARBON-DIOXIDE REACTIVITYPOSITRON-EMISSION-TOMOGRAPHYNITROUS-OXIDE 50-PERCENTCEREBROVASCULAR RESISTANCEPERFUSION-PRESSUREMETABOLIC-RATEINTRACRANIAL-PRESSURENONCARDIAC SURGERY