Anaesthetic techniques to prevent perioperative stroke

Area of Science:

• Anesthesiology
• Neurology
• Cardiology

Background:

• Perioperative stroke significantly increases patient morbidity and mortality.
• Identifying patients at high risk for perioperative stroke is crucial for effective management.

Purpose of the Study:

• To summarize techniques and interventions for anesthesiologists to minimize perioperative stroke risk.
• To review current neuroprotective approaches and management strategies for high-risk surgical patients.

Main Methods:

• Review of risk factors for perioperative stroke, including non-modifiable factors like prior stroke.
• Evaluation of the role of antiplatelet therapy continuation in high-risk cardiovascular patients.
• Assessment of neuroprotective strategies such as remote ischemic preconditioning.

Main Results:

• Non-modifiable risk factors aid in identifying high-risk patients.
• Continuation of antiplatelet therapy is recommended even for surgeries with high bleeding risk.
• Remote ischemic preconditioning is a notable neuroprotective approach.

Conclusions:

• Neuromonitoring is essential for immediate detection of impaired cerebral blood flow.
• Statins initiated preoperatively and continuation of statins and beta-blockers may reduce stroke rates.
• Maintaining baseline cerebral perfusion pressure, avoiding hypoglycemia, and managing hyperglycemia (above 150 mg/dl) are critical. Experienced anesthesiologists are vital for individualizing care.