[Anesthesia and postoperative stroke in patients with previous cerebrovascular disease]

A retrospective study was performed to determine the incidence of perioperative stroke in patients with previous history of cerebrovascular disease (CVD). One hundred and seventy eight out of 20048 patients who underwent anesthesia and surgery during the period of 1985 to 1989 had history of prior CVD. Of them, 137 patients were managed with general anesthesia and 41 with regional anesthesia. Factors analyzed were interval between the prior CVD and the operation, intraoperative hemodynamic changes, perioperative changes in the hematocrit and urinary output, and postoperative neurological complications. Postoperative neurological complications occurred in 31 of the patients given general anesthesia (delayed awakening in 26, dementia syndrome in 6 and deterioration of paralysis in 1), whereas only one patient developed dementia syndrome postoperatively in those given regional anesthesia. None of the patients developed a postoperative stroke. There was no direct relationship between the factors analyzed and the incidence of postoperative neurological complications. Further studies are needed to identify more precisely factors contributing to the occurrence of cerebrovascular complication in a high risk patients.