Raising the Alarm on Brain Attacks in Surgical Patients: Are We Doing Enough to Prevent and Treat Postoperative Strokes?

L. Glance, R. Holloway
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引用次数: 2

Abstract

This editorial provides an overview of the study by Christiansen et al, which demonstrates that a history of acute ischemic stroke within 3 months of emergency noncardiac, nonintracranial surgery significantly increased the risk of a postoperative stroke using data from the Danish National Patient Registry. The incidence of postoperative stroke was reported at 0.1% to 0.7%, with the risk declining as more time elapsed between the ischemic event and surgery. Despite the study limitations, this research by Christiansen et al on vulnerability to stroke after surgery supports the need for further research using different approaches and diverse populations to support the validation of the risk. Awareness of the risk of stroke, new neurologic deficits, and clear procedures with stroke teams and perioperative and surgical teams should be in place to ensure better patient outcomes. When undergoing elective surgery, especially in high-risk patients/ procedures, management must be done in close conjunction with stroke teams and comprehensive stroke centers where neuroendovascular specialists and advanced neuroimaging capabilities are readily available to ensure a better quality of care, as well as a better quality of life postprocedure. As of 2017, across America, there are 121 comprehensive stroke centers. When a specialized center is not readily accessible, a protocol to manage at-risk patients via technology, such as telestroke consultation, must be implemented. Currently, the guidelines for preventing postoperative stroke are provided by the Society for Neuroscience in Anesthesiology and Critical Care consensus statement (supported but not endorsed by the American Society of Anesthesiologists). These guidelines have been minimally disseminated in comparison to the information from theAmerican StrokeAssociation. Because of the potential for severe impact on the life of a patient, surgical patients at risk of postoperative stroke must be managed with as much importance given to preventing a recurrent stroke as with dealing with the medical condition being treated.
敲响外科患者脑梗死的警钟:我们在预防和治疗术后中风方面做得足够吗?
这篇社论概述了Christiansen等人的研究,该研究利用丹麦国家患者登记处的数据表明,紧急非心脏、非颅内手术后3个月内的急性缺血性卒中史显著增加了术后卒中的风险。据报道,术后卒中的发生率为0.1% - 0.7%,随着缺血事件和手术之间时间的延长,卒中风险下降。尽管研究存在局限性,但Christiansen等人关于手术后卒中易感性的研究表明,有必要使用不同的方法和不同的人群进行进一步的研究,以支持对风险的验证。卒中风险的认识、新的神经功能缺陷、卒中团队、围手术期和外科团队的明确程序应该到位,以确保更好的患者预后。当接受选择性手术时,特别是高风险患者/手术,必须与中风团队和综合中风中心密切合作,在这些中心,神经血管内专家和先进的神经成像能力随时可用,以确保更好的护理质量,以及手术后更好的生活质量。截至2017年,全美共有121家综合性中风中心。当一个专门的中心不容易到达时,必须实施一项协议,通过技术来管理高危患者,如远程卒中咨询。目前,预防术后卒中的指导方针是由麻醉和重症监护神经科学学会共识声明提供的(美国麻醉医师学会支持但不认可)。与美国中风协会的信息相比,这些指南的传播程度最低。由于可能对患者的生命造成严重影响,手术患者术后卒中风险的管理必须与处理正在治疗的医疗状况一样重视预防卒中复发。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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