Perioperative stroke – Prediction, Prevention, and Protection

Nagre, Amarja Sachin

doi:10.4103/ija.ija_292_18

Cited by 15 publications

(10 citation statements)

References 32 publications

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“…Interestingly, the risk factors found for stroke have also been implicated as the same post-CABG risk factors for mortality following occurrence of stroke. 18,19 Our study and previous studies show that the Hazard ratios and 95% confidence intervals (whiskers) for each predictor from stroke patients compared with non-stroke patients for survival past 1 year. Hazard ratios correspond to the shift in the hazard function attributable to the predictor.…”

Section: Discussionsupporting

confidence: 53%

Factors associated with long-term survival in patients with stroke after coronary artery bypass grafting

et al. 2020

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Objective Occurrence of a stroke within 30 days following coronary artery bypass grafting (CABG) is an uncommon, but often devastating, complication. This study aimed to identify factors associated with long-term survival (beyond 30 days) in patients with stroke after CABG. Methods De-identified patients’ records from the Veterans Affairs Surgical Quality Improvement Program database were used to identify risk factors and perioperative complications associated with survival for up to 20 years in patients with post-CABG stroke. The multivariable Cox proportional hazards model was used for analyzing survival. Results The median survival time for patients with stroke (n = 1422) was 6.7 years. The mortality rate for these patients was highest in the first year post-CABG and was significantly elevated compared with non-stroke patients. Survival rates at 1, 5, and 10 years for stroke versus non-stroke patients were 79% vs. 96%, 58% vs. 83%, and 36% vs. 63%, respectively. High preoperative serum creatinine levels, postoperative occurrence of renal failure, prolonged ventilation, coma, and reoperation for bleeding were important predictors of 1-year mortality of patients with post-CABG stroke. Conclusions Veterans with post-CABG stroke have a considerably higher risk for mortality during the first year compared with patients without stroke.

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Section: Discussionsupporting

confidence: 53%

Factors associated with long-term survival in patients with stroke after coronary artery bypass grafting

et al. 2020

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“…The low-risk group includes procedures in the field of endocrinology, ophthalmology, dentistry, urology and minor orthopaedic procedures. [25,26]. Risk reduction strategies include: -implementation of appropriate pharmacological treatment (β-blockers, stains, acetylsalicylic acid), -prophylactic coronary revascularization, -appropriate premedication mixtures (non-steroidal anti-inflammatory drugs with analgesic effect, benzodiazepines, proton pump inhibitors and antiemetic drugs when the patient declares the syndrome of postoperative nausea and vomiting -PONV), -selection of appropriate anaesthesia, if possible (general anaesthesia with intubation, epidural, spinal anaesthesia, general anaesthesia with the use of a laryngeal/face mask, regional anaesthesia, peripheral conduction anaesthesia) [27,28].…”

Section: Discussionmentioning

confidence: 99%

The Level of Knowledge of Nurses in Surgical Departments about the Occurrence of Stroke in Patients in the Postoperative Period

Rucińska

Skrzypek-Czerko

Roszmann

et al. 2020

PNN

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Introduction. Each year 80 000 Poles are suffering from stroke. The most common risk factors are hypertension, diabetes and complications, hyperlipidemia, obesity, atrial fibrillation. Lifestyle modification, such as diseases controlling, diet changing, exercises, stop smoking and limiting alcohol consumption are known as stroke prevention. Thrombectomy and thrombolytic therapy definitely increase long-term survival and prognosis. Aim. Objective of the work is assessment of surgical nurses knowledge level about postoperative stroke. Material and Methods. The research was conducted on a group of 55 randomly chosen surgical nurses. The diagnostic survey method with a proprietary questionnaire was used for the research. Results. Nurses knowledge was poor. Education and age affect to answers. Higher education qualification nurses have higher knowledge level relative to less educated nurses. Younger nurses have higher knowledge level than older nurses. Conclusions. Cardiosurgery and vascular surgery are charged as the most risk onset postoperative stroke. Knowledge of surgical nurses about risk factors, prevention, symptom, complications and procedures in case of stroke onset have particular meaning in postoperative caring. (JNNN 2020;9(4):138–144) Key Words: knowledge, nursing care, postoperative period, stroke

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“…Intra-operative hypotension (IOH) has been associated with adverse outcomes[1] in terms of kidney[2345] and myocardial injury,[3467] as well as mortality,[89] and probably also stroke. [1011] Therefore, prevention of IOH may be a key in further improving patient outcome.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative hypotension and its prediction

Vos

Scheeren

2019

Indian J Anaesth

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Intraoperative hypotension (IOH) very commonly accompanies general anaesthesia in patients undergoing major surgical procedures. The development of IOH is unwanted, since it is associated with adverse outcomes such as acute kidney injury and myocardial injury, stroke and mortality. Although the definition of IOH is variable, harm starts to occur below a mean arterial pressure (MAP) threshold of 65 mmHg. The odds of adverse outcome increase for increasing duration and/or magnitude of IOH below this threshold, and even short periods of IOH seem to be associated with adverse outcomes. Therefore, reducing the hypotensive burden by predicting and preventing IOH through proactive appropriate treatment may potentially improve patient outcome. In this review article, we summarise the current state of the prediction of IOH by the use of so-called machine-learning algorithms. Machine-learning algorithms that use high-fidelity data from the arterial pressure waveform, may be used to reveal 'traits' that are unseen by the human eye and are associated with the later development of IOH. These algorithms can use large datasets for 'training', and can subsequently be used by clinicians for haemodynamic monitoring and guiding therapy. A first clinically available application, the hypotension prediction index (HPI), is aimed to predict an impending hypotensive event, and additionally, to guide appropriate treatment by calculated secondary variables to asses preload (dynamic preload variables), contractility (dP/dtmax), and afterload (dynamic arterial elastance, Eadyn). In this narrative review, we summarise the current state of the prediction of hypotension using such novel, automated algorithms and we will highlight HPI and the secondary variables provided to identify the probable origin of the (impending) hypotensive event.

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Perioperative stroke – Prediction, Prevention, and Protection

Cited by 15 publications

References 32 publications

Factors associated with long-term survival in patients with stroke after coronary artery bypass grafting

Factors associated with long-term survival in patients with stroke after coronary artery bypass grafting

The Level of Knowledge of Nurses in Surgical Departments about the Occurrence of Stroke in Patients in the Postoperative Period

Intraoperative hypotension and its prediction

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