Recognizing Strokes in the Post-Anesthesia Care Unit in Adult Versus Pediatric Patients

Postoperative strokes can occur in adult and pediatric patients, with both ischemic and hemorrhagic etiologies. Unfortunately, it can be difficult to distinguish stroke symptoms from lingering anesthetic-related neurological effects. Even though there is currently no standardized screening tool, a systematic approach to symptomatic differentiation between anesthetic effects and stroke symptoms can help ensure early diagnosis of a stroke and thus minimize both morbidity and mortality.

This review aims to provide an overview of perioperative stroke in pediatric and adult patients, including epidemiology, clinical presentation, and risk factors, as well as an approach to differentiating suspected stroke from anesthetic-related neurological effects in the post-anesthesia care unit (PACU).

In addition to symptomatology, stroke recognition in the PACU may be facilitated by incorporating consideration of the many perioperative stroke risk factors including surgery type, medications, and both modifiable and non-modifiable patient risk factors. While PACU strokes are rare, any delay in diagnosis and thus treatment can exacerbate adverse outcomes, so it remains important to maintain suspicion of stroke in patients with concerning symptoms and risk factors.

This focused review discusses stroke etiology, its varying risk factors and symptomatology in pediatric and adult patients, and appropriate steps to take when confronted with concerning neurological symptoms in the PACU.