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Perioperative ischemic stroke in non-cardiovascular surgery patients

  • Review Article
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Abstract

Perioperative ischemic stroke occurs in approximately 0.08–0.7% of patients after non-cardiovascular surgery and confers a significant risk of morbidity and mortality. The mortality rate of this major complication is similar in non-cardiovascular and cardiovascular surgery. Its incidence appears to be similar in Japan, Europe, and the United States. Perioperative physicians should be aware of the pathophysiology and predictors of ischemic stroke, and the anti-thrombotic strategies to prevent it. The main causes of perioperative ischemic stroke include cerebral atherothrombosis; lacuna stroke; cardiac thrombi due to atrial fibrillation; dehydration; hypotension; and perioperative systemic hypercoagulability. Perioperative management includes detailed informed consent regarding potential stroke risks, counseling, careful surgical treatment decisions, and identification of the high-risk patient for perioperative antithrombotic strategies. The 2009 Japanese guidelines for the management of stroke recommend using the appropriate intravenous infusions to avoid dehydration and consideration of anticoagulation in the patients who are at high risk for thrombosis and embolism while antithrombotic agents are discontinued. Understanding how to prevent perioperative ischemic stroke remains a challenge. In this article, we review the incidence, timing of the occurrence, mortality, risk factors, and pathophysiology of perioperative ischemic stroke in the non-cardiovascular surgery patient.

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Acknowledgments

The authors are thankful to Dr. Kuniyoshi Tanaka (Department of Cardiothoracic and Vascular surgery, Hamamatsu Medical Center, Hamamatsu, Japan) for his thoughtful critiques and comments on this review article.

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Authors and Affiliations

  1. Department of Anesthesiology, Hamamatsu Medical Center, 328 Tomizuka, Hamamatsu, 432-8580, Japan

    Mutsuhito Kikura

  2. Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Brian T. Bateman

  3. Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA

    Kenichi A. Tanaka

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  1. Mutsuhito Kikura
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  2. Brian T. Bateman
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  3. Kenichi A. Tanaka
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Correspondence to Mutsuhito Kikura.

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Kikura, M., Bateman, B.T. & Tanaka, K.A. Perioperative ischemic stroke in non-cardiovascular surgery patients. J Anesth 24, 733–738 (2010). https://doi.org/10.1007/s00540-010-0969-3

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  • DOI: https://doi.org/10.1007/s00540-010-0969-3

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