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Ischemic Stroke Management: Posthospitalization and Transition of Care
Am Fam Physician. 2023 Jul;108(1):70-77.ABSTRACTIschemic stroke is a major cause of morbidity and mortality worldwide. Ischemic stroke and transient ischemic attack exist on a continuum of the same disease process. Ischemic stroke is common, and more than 85% of stroke risk is attributed to modifiable risk factors. The initial management of acute stroke is usually performed in the emergency department and hospital settings. Family physicians have a key role in follow-up, ensuring that a complete diagnostic evaluation has been performed, addressing modifiable risk factors, facilitating rehabilitation, and managing chronic s...
Source: Pain Physician - July 13, 2023 Category: Anesthesiology Authors: Scott T Larson Brigit E Ray Jason Wilbur Source Type: research

Challenges in the Anesthetic and Intensive Care Management of Acute Ischemic Stroke
Acute ischemic stroke (AIS) is a devastating condition with high morbidity and mortality. In the past 2 decades, the treatment of AIS has been revolutionized by the introduction of several interventions supported by class I evidence—care on a stroke unit, intravenous tissue plasminogen activator within 4.5 hours of stroke onset, aspirin commenced within 48 hours of stroke onset, and decompressive craniectomy for supratentorial malignant hemispheric cerebral infarction. There is new class I evidence also demonstrating benefits of endovascular therapy on functional outcomes in those with anterior circulation stroke. In add...
Source: Journal of Neurosurgical Anesthesiology - June 9, 2016 Category: Anesthesiology Tags: Review Articles Source Type: research

Acute management of ischaemic stroke
Publication date: Available online 19 December 2019Source: Anaesthesia & Intensive Care MedicineAuthor(s): Deborah R. Douglas, Valpuri Luoma, Ugan ReddyAbstractAn acute ischaemic stroke (AIS) is a non-specific state of brain injury with neuronal dysfunction that has several pathophysiologic causes and is time critical. More than 70% of cases are due to thrombotic or embolic causes with resultant focal ischaemia and an accompanying neurological deficit. Initial assessment, stabilization and early imaging are important aspects of effective stroke management. Over the last two decades, thrombolysis and mechanical thrombectomy...
Source: Anaesthesia and intensive care medicine - December 20, 2019 Category: Anesthesiology Source Type: research

Perioperative stroke following transurethral resection of prostate: high index of suspicion and stabilization of physiological parameters can save lives.
We report a case of a 72 year old hypertensive male who developed severe hypertension followed by neurological deterioration in the immediate postoperative period after transurethral resection of prostate. While arterial blood gas and laboratory tests excluded transurethral resection of prostate syndrome or any other metabolic cause, reduction of blood pressure failed to ameliorate the symptoms. A cranial CT done 4hours after the onset of neurological symptoms revealed bilateral gangliocapsular and right thalamic infarcts. Oral aspirin was advised to prevent early recurrent stroke. Supportive treatment and mechanical venti...
Source: Revista Brasileira de Anestesiologia - January 15, 2017 Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research

Perioperative stroke following TURP: high index of suspicion and stabilization of physiological parameters can save lives
We report a case of a 72 year old hypertensive male who developed severe hypertension followed by neurological deterioration in the immediate postoperative period after TURP. While arterial blood gas and laboratory tests excluded TURP syndrome or any other metabolic cause, reduction of blood pressure failed to ameliorate the symptoms. A cranial CT done 4h after the onset of neurological symptoms revealed bilateral gangliocapsular and right thalamic infarcts. Oral aspirin was advised to prevent early recurrent stroke. Supportive treatment and mechanical ventilation ensured physiological stability and the patient recovered c...
Source: Brazilian Journal of Anesthesiology - June 21, 2016 Category: Anesthesiology Source Type: research

Perioperative stroke following transurethral resection of prostate: high index of suspicion and stabilization of physiological parameters can save lives
We report a case of a 72 year old hypertensive male who developed severe hypertension followed by neurological deterioration in the immediate postoperative period after transurethral resection of prostate. While arterial blood gas and laboratory tests excluded transurethral resection of prostate syndrome or any other metabolic cause, reduction of blood pressure failed to ameliorate the symptoms. A cranial CT done 4hours after the onset of neurological symptoms revealed bilateral gangliocapsular and right thalamic infarcts. Oral aspirin was advised to prevent early recurrent stroke. Supportive treatment and mechanical venti...
Source: Brazilian Journal of Anesthesiology - June 28, 2018 Category: Anesthesiology Source Type: research

Cerebellar infarct following orchidopexy under spinal anesthesia
Publication date: Available online 6 August 2018Source: Brazilian Journal of Anesthesiology (English Edition)Author(s): Sunny Goel, Gaurav Garg, Manoj Kumar, Ruchir AeronAbstractThe report describes a case of peri-operative stroke that presented as diplopia and gait difficulty on 2nd post-operative day after routine orchidopexy under spinal anesthesia in an otherwise healthy young boy. Magnetic resonance imaging of the brain revealed acute infarct in bilateral cerebellar hemispheres, left half of medulla and left thalamus. A diagnosis of acute stroke (infarct) was made and patient was started on oral aspirin 75 mg.day...
Source: Brazilian Journal of Anesthesiology - August 7, 2018 Category: Anesthesiology Source Type: research

Cerebellar infarct following orchidopexy under spinal anesthesia.
Authors: Goel S, Garg G, Kumar M, Aeron R Abstract The report describes a case of peri-operative stroke that presented as diplopia and gait difficulty on 2nd post-operative day after routine orchidopexy under spinal anesthesia in an otherwise healthy young boy. Magnetic resonance imaging of the brain revealed acute infarct in bilateral cerebellar hemispheres, left half of medulla and left thalamus. A diagnosis of acute stroke (infarct) was made and patient was started on oral aspirin 75mg.day-1, following which his vision started improving after 2 weeks. Possible mechanisms of development of stroke in the peri-oper...
Source: Revista Brasileira de Anestesiologia - November 19, 2018 Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research

Aspirin in the perioperative period: a review of the recent literature
Purpose of review: The indications for aspirin (ASA) for both primary and secondary prevention of thrombotic events continue to evolve. We review some of these indications and the recent literature regarding the perioperative administration of ASA. Recent findings: ASA for primary prevention of cardiac ischemia, stroke, cancer, and death remains controversial. When used for primary prevention, ASA may be safely discontinued perioperatively. Patients with coronary or carotid artery stents should continue to receive ASA perioperatively. For patients with ischemic heart disease currently receiving ASA for secondary prevention...
Source: Current Opinion in Anaesthesiology - May 1, 2015 Category: Anesthesiology Tags: ANESTHESIA AND MEDICAL DISEASE: Edited by Natalie F. Holt Source Type: research

Neuraxial block and postoperative epidural analgesia: effects on outcomes in the POISE-2 trial
Conclusions. Neuraxial block and postoperative epidural analgesia were not associated with adverse cardiovascular outcomes among POISE-2 subjects.
Source: British Journal of Anaesthesia - December 16, 2015 Category: Anesthesiology Authors: Leslie, K., McIlroy, D., Kasza, J., Forbes, A., Kurz, A., Khan, J., Meyhoff, C. S., Allard, R., Landoni, G., Jara, X., Lurati Buse, G., Candiotti, K., Lee, H.-S., Gupta, R., VanHelder, T., Purayil, W., De Hert, S., Treschan, T., Devereaux, P. J. Tags: Regional Anaesthesia Source Type: research

New therapy in cardioprotection
Purpose of review: An increasing number of patients are presenting for major surgery with cardiovascular comorbidities. Evidence of myocardial injury was found in 8% of all noncardiac surgery patients older than 45 years and was associated with adverse outcome. For this reason, there has been a lot of interest in finding and evaluating effective cardioprotective interventions. Recent findings: Current evidence suggests that statins, volatile anesthetic agents, and propofol are cardioprotective. Beta blockers reduce myocardial injury, but the resultant hypotension may contribute to the increased all-cause mortality and stro...
Source: Current Opinion in Anaesthesiology - July 3, 2015 Category: Anesthesiology Tags: DRUGS IN ANESTHESIA: Edited by Tong J. Gan Source Type: research

Peri‐operative cardiac protection for non‐cardiac surgery
Summary Cardiovascular complications are an important cause of morbidity and mortality after non‐cardiac surgery. Pre‐operative identification of high‐risk individuals and appropriate peri‐operative management can reduce cardiovascular risk. It is important to continue chronic beta‐blocker and statin therapy. Statins are relatively safe and peri‐operative initiation may be beneficial in high‐risk patients and those scheduled for vascular surgery. The pre‐operative introduction of beta‐blockers reduces myocardial injury but increases rates of stroke and mortality, possibly due to hypotension. They should o...
Source: Anaesthesia - December 1, 2015 Category: Anesthesiology Authors: S. S. C. Wong, M. G. Irwin Tags: Review Article Source Type: research

Impact of aspirin use on morbidity and mortality in massively transfused cardiac surgery patients: a propensity score matched cohort study
Conclusions Preoperative aspirin use is not associated with decreased in-hospital mortality in massively transfused cardiac surgery patients, but may be associated with less mechanical lung ventilation time.
Source: Journal of Anesthesia - July 4, 2016 Category: Anesthesiology Source Type: research

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