Pathophysiological and clinical considerations in the perioperative care of patients with a previous ischaemic stroke: a multidisciplinary narrative review. (February 2020)

• Record Type: Journal Article
• Authors: Minhas, Jatinder S.; Rook, William; Panerai, Ronney B.; Hoiland, Ryan L.; Ainslie, Phil N.; Thompson, Jonathan P.; Mistri, Amit K.; Robinson, Thompson G.
• Is Part Of: British journal of anaesthesia. Volume 124:Number 2(2020)
• Page Start: 183
• Page End: 196
• Publication Date: 2020-02
• Subjects: acute ischaemic stroke -- anaesthesia -- blood pressure -- cerebral perfusion -- endovascular therapy -- haemodynamics -- prevention -- thrombolysis; Anesthesiology -- Periodicals; Anesthesia -- Periodicals; 617.9605
• DOI: 10.1016/j.bja.2019.10.021
• Languages: English
• ISSNs: 0007-0912

Abstract

Summary: 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.