Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association

Curtis Benesch; Laurent G Glance; Colin P Derdeyn; Lee A Fleisher; Robert G Holloway; Steven R Messé; Christina Mijalski; M Timothy Nelson; Martha Power; Babu G Welch

doi:10.1161/CIR.0000000000000968

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Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association

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Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association

Curtis Benesch, Laurent G Glance, Colin P Derdeyn, Lee A Fleisher, Robert G Holloway, Steven R Messé, Christina Mijalski, M Timothy Nelson, Martha Power and Babu G Welch

Circulation (New York, N.Y.), Vol.143(19), pp.e923-e946

04/08/2021

DOI: 10.1161/CIR.0000000000000968

PMID: 33827230

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Abstract

Perioperative stroke is a potentially devastating complication in patients undergoing noncardiac, nonneurological surgery. This scientific statement summarizes established risk factors for perioperative stroke, preoperative and intraoperative strategies to mitigate the risk of stroke, suggestions for postoperative assessments, and treatment approaches for minimizing permanent neurological dysfunction in patients who experience a perioperative stroke. The first section focuses on preoperative optimization, including the role of preoperative carotid revascularization in patients with high-grade carotid stenosis and delaying surgery in patients with recent strokes. The second section reviews intraoperative strategies to reduce the risk of stroke, focusing on blood pressure control, perioperative goal-directed therapy, blood transfusion, and anesthetic technique. Finally, this statement presents strategies for the evaluation and treatment of patients with suspected postoperative strokes and, in particular, highlights the value of rapid recognition of strokes and the early use of intravenous thrombolysis and mechanical embolectomy in appropriate patients.

Stroke

therapeutics

surgical procedures, operative

complications

embolectomy

thrombectomy

ischemic stroke

AHA Scientific Statements

Details

Title: Subtitle: Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery: A Scientific Statement From the American Heart Association/American Stroke Association
Creators: Curtis Benesch
Laurent G Glance
Colin P Derdeyn
Lee A Fleisher
Robert G Holloway
Steven R Messé
Christina Mijalski
M Timothy Nelson
Martha Power
Babu G Welch
Resource Type: Journal article
Publication Details: Circulation (New York, N.Y.), Vol.143(19), pp.e923-e946
DOI: 10.1161/CIR.0000000000000968
PMID: 33827230
NLM abbreviation: Circulation
ISSN: 0009-7322
eISSN: 1524-4539
Publisher: Lippincott Williams & Wilkins; United States
Language: English
Date published: 04/08/2021
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984071719202771

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