Anaesthetic techniques to prevent perioperative stroke.

PURPOSE OF REVIEW: Different techniques and interventions that can be used by an anaesthesiologist to minimize the perioperative stroke risk are summarized.

RECENT FINDINGS: The most important risk factors for perioperative stoke are not modifiable, for example previous stroke or renal failure, but they can be used to identify patients with a high risk for perioperative stroke. The antiplatelet therapy should be continued in patients with a high risk for cardiovascular thrombosis. This might be true even for operations in which bleeding should be strictly avoided such as eye surgery. One of the most recent neuroprotective approaches is the remote ischaemic preconditioning.

SUMMARY: Perioperative stroke increases morbidity and mortality of patients undergoing surgery and is therefore highly relevant. Neuromonitoring should be used to detect a deterioration of cerebral blood flow and oxygen supply immediately. Statins which are initiated at least 2 weeks before the operation can possibly reduce the perioperative stroke rate. Routinely taken statins should not be terminated and this is also true for β-blockers. The cerebral perfusion pressure should be kept at baseline levels, whereas a mild hypercapnia theoretically could be beneficial. Hypoglycemia has to be avoided while treatment of high blood glucose levels should be started when they exceed 150 mg/dl. The anesthesia for patients with a high risk for stroke has always to be performed by an experienced anaesthesiologist who is able to individualize the therapeutic interventions.