Perioperative stroke: the noncardiac surgery patient

This chapter reviewed the mechanisms and manifestations of transient and irreversible cerebral ischemia and the current experimental approaches to attenuate ischemic neuronal injury. Patients with signs or symptoms of cerebral ischemia are likely to have abnormal cerebrovascular dynamics, with areas of cerebrum at risk, and may be at an increased risk of stroke after general or vascular surgery. Such patients also have a very high frequency of associated cardiac disease. In this chapter, guidelines for anesthetic management of patients with symptomatic CVD undergoing noncardiac surgery were based on current understanding of the pathophysiology of cerebral ischemia. Nonetheless, the available data indicate that most perioperative strokes occur in the postoperative period and appear to be thromboembolic in nature. The existence of neither asymptomatic carotid bruits nor intraoperative hypotension appears to be associated with the occurrence of perioperative stroke.