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Appleton JP, Mullhi R, Singh N. Initial management of acute ischaemic stroke. Br J Hosp Med (Lond) 2021; 82:1-9. [PMID: 33512281 DOI: 10.12968/hmed.2020.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The management of acute ischaemic stroke has been revolutionised by effective reperfusion therapies including thrombolysis and mechanical thrombectomy. In particular, mechanical thrombectomy has heralded a new era in stroke medicine. There have also been developments to improve clinical outcomes for patients who have had an acute ischaemic stroke but are not eligible for this procedure. This article presents an update on the initial management of acute ischaemic stroke, including reperfusion therapies, periprocedural considerations and ongoing research for potential improvements in the care of these patients.
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Affiliation(s)
- Jason P Appleton
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Randeep Mullhi
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Naginder Singh
- Department of Anaesthesia and Intensive Care Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Minhas JS, Rook W, Panerai RB, Hoiland RL, Ainslie PN, Thompson JP, Mistri AK, Robinson TG. Pathophysiological and clinical considerations in the perioperative care of patients with a previous ischaemic stroke: a multidisciplinary narrative review. Br J Anaesth 2020; 124:183-196. [PMID: 31813569 PMCID: PMC7034810 DOI: 10.1016/j.bja.2019.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/24/2019] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
With an ageing population and increasing incidence of cerebrovascular disease, an increasing number of patients presenting for routine and emergency surgery have a prior history of stroke. This presents a challenge for pre-, intra-, and postoperative management as the neurological risk is considerably higher. Evidence is lacking around anaesthetic practice for patients with vascular neurological vulnerability. Through understanding the pathophysiological changes that occur after stroke, insight into the susceptibilities of the cerebral vasculature to intrinsic and extrinsic factors can be developed. Increasing understanding of post-stroke systemic and cerebral haemodynamics has provided improved outcomes from stroke and more robust secondary prevention, although this knowledge has yet to be applied to our delivery of anaesthesia in those with prior stroke. This review describes the key pathophysiological and clinical considerations that inform clinicians providing perioperative care for patients with a prior diagnosis of stroke.
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Affiliation(s)
- Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK.
| | - William Rook
- Academic Department of Anaesthesia, Critical Care, Pain, and Resuscitation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ryan L Hoiland
- Centre for Heart, Lung, and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Phil N Ainslie
- Centre for Heart, Lung, and Vascular Health, University of British Columbia, Kelowna, BC, Canada
| | - Jonathan P Thompson
- Anaesthesia and Critical Care, Department of Cardiovascular Sciences, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Amit K Mistri
- University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK
| | - Thompson G Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHIASM) Research Group, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; National Institute for Health Research, Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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Morrison C, Aravindan S, Rennie A, Liversedge T. Stroke management in children. Paediatr Anaesth 2020; 30:17-24. [PMID: 31733159 DOI: 10.1111/pan.13768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Christa Morrison
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
| | | | - Adam Rennie
- Department of Interventional Radiology, Great Ormond Street Hospital, London, UK
| | - Tim Liversedge
- Department of Anaesthesia, Great Ormond Street Hospital, London, UK
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Land of confusion: anaesthetic management during thrombectomy for acute ischaemic stroke. Br J Anaesth 2019; 122:300-304. [DOI: 10.1016/j.bja.2018.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 11/17/2022] Open
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