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Good Morning. 10 June 2002. Perioperative Stroke Prevention. R 2 林子富. Anaesthesia 1997;52:879-83. Incidence 0.02 to 0.7% In the postoperative period (the majority events) The average time : 7 days after surgery Anaesthesia 1997;52:879-83 Significance High mortality

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Good Morning

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  1. Good Morning 10 June 2002

  2. Perioperative Stroke Prevention R2林子富

  3. Anaesthesia 1997;52:879-83

  4. Incidence • 0.02 to 0.7% • In the postoperative period (the majority events) • The average time : 7 days after surgery Anaesthesia 1997;52:879-83 • Significance • High mortality • Assisted care for living • Large impact and cost

  5. Risk Factors • Perioperative period itself • Type of surgery • Coexisting conditions • Cardiac disease • Age • Others • hypotension, dehydration, hypercoagulable state and emergency surgery Anesthesiology 2000;92:425-32

  6. Pathophysiology • Intraoperative hypotension • Thrombotic or embolic events – more important • Hypercoagulable state after surgery • Others • Extended bad rest • Thrombogenic devices • Dehydration Stroke 1982;13:766-73

  7. Prevention • Identifying patients at risk (ex. CVA) • Altering risk factors (ex. delay surgery for 4-6 wk) • Carotid endarterectomy for carotid stenosis? • Consumption of aspirin? • Control of hypertension • Good anesthetic technique • Effect of anesthetic agents on postoperative hypercoagulability (ex. propofol) Anaesth Intensive Care 2000;28:227-28

  8. Cerebral Protection Techniques • To increase the supply of oxygen to the injured tissue • To reduce the metabolic demands • To affect specific pathways in the ischemic cascade to reduce the production of unwanted metabolites

  9. Cerebral Protection • Physiological • BP maintained within 20% of normal range • Maintain CPP greater than 70 mm Hg • Hemodilution • Maintain normocarbia • Mild hypothermia • Treat fever aggressively • Avoid hyperglycemia

  10. Cerebral Protection • Anesthetic Agents • Barbiturates • Isoflurane • Propofol • Lidocaine Anesthesiology 1999;90:1446-53 Anesthesiology 2000;93:858-75

  11. Cerebral Protection • Other Pharmacological Agents • Calcium antagonist • Magnesium • Other agents under investigation • Prostanoids • Free radical scavengers • Lipid membrane peroxidation inhibitors • NMDA receptor antagonists Stroke 1992;23:3-8

  12. Summary • Uncommon but devastating • Knowledge of important risk factors • Measures to prevent ischemic cerebral events • Current and experimental pharmaceutical agents

  13. Have A Nice Day

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