nach oben

Die Anaesthesiologie

Erschienen in:

04.08.2020 | Anästhetika | Leitthema

Perioperativer Schlaganfall

verfasst von: PD Dr. M. Fischer, Dr. U. Kahl

Erschienen in: Die Anaesthesiologie | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Zusammenfassung

Der perioperative Schlaganfall ist definiert als eine zerebrale Ischämie, die in unmittelbarem Zusammenhang während oder innerhalb der ersten 30 Tage nach einer Operation auftritt und mit einem erhöhten Mortalitätsrisiko einhergeht. Abhängig von der Art des Eingriffs wird bei bis zu 11 % aller Patienten ein Schlaganfall in der postoperativen Phase diagnostiziert. Insbesondere Patienten mit einem ischämischen Schlaganfall oder einer transitorischen ischämischen Attacke in der Vorgeschichte sind einem hohen Risiko ausgesetzt, einen erneuten Schlaganfall perioperativ zu erleiden, weshalb die Wahl des Operationszeitpunktes sowie ein individualisiertes Blutdruckmanagement zur Optimierung der zerebralen Perfusion essenziell sind.

Basierend auf einer selektiven Literaturrecherche fasst diese Übersicht Epidemiologie, Risikofaktoren und Ätiologie perioperativer Schlaganfälle zusammen und stellt mögliche präventive Maßnahmen vor, die im anästhesiologischen Alltag von besonderer Relevanz sind.

Rosenberger P, Drexler B (2017) Development of anaesthesia-related mortality and impact on perioperative outcome. Anasthesiol Intensivmed Notfallmed Schmerzther 52(7-08):486–497PubMed

Mack MJ, Acker MA, Gelijns AC, Overbey JR, Parides MK, Browndyke JN et al (2017) Effect of cerebral embolic protection devices on CNS infarction in surgical aortic valve replacement: a randomized clinical trial. JAMA 318(6):536–547PubMedPubMedCentral

Williams JB, Peterson ED, Zhao Y, O’Brien SM, Andersen ND, Miller DC et al (2012) Contemporary results for proximal aortic replacement in North America. J Am Coll Cardiol 60(13):1156–1162PubMedPubMedCentral

Mrkobrada M, Hill MD, Chan MTV, Sigamani A, Cowan D, Kurz A et al (2016) Covert stroke after non-cardiac surgery: a prospective cohort study. Br J Anaesth 117(2):191–197PubMed

Sun X, Lindsay J, Monsein LH, Hill PC, Corso PJ (2012) Silent brain injury after cardiac surgery: a review: cognitive dysfunction and magnetic resonance imaging diffusion-weighted imaging findings. J Am Coll Cardiol 60(9):791–797PubMed

Mashour GA, Shanks AM, Kheterpal S (2011) Perioperative stroke and associated mortality after noncardiac, nonneurologic surgery. Anesthesiology 114(6):1289–1296PubMed

GBD 2016 Stroke Collaborators (2019) Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol 18(5):439–458

Kohler M, Deutschbein J, Peschke D, Schenk L (2014) Stroke occurence in Germany—on the comparability of insurance data and registry-based data. Fortschr Neurol Psychiatr 82(11):627–633PubMed

Ng JLW, Chan MTV, Gelb AW (2011) Perioperative stroke in noncardiac, nonneurosurgical surgery. Anesthesiology 115(4):879–890PubMed

10.

Bateman BT, Schumacher HC, Wang S, Shaefi S, Berman MF (2009) Perioperative acute ischemic stroke in noncardiac and nonvascular surgery: incidence, risk factors, and outcomes. Anesthesiology 110(2):231–238PubMed

11.

Vlisides P, Mashour GA (2016) Perioperative stroke. Can J Anaesth 63(2):193–204PubMed

12.

Bijker JB, Gelb AW (2013) Review article: the role of hypotension in perioperative stroke. Can J Anaesth 60(2):159–167PubMed

13.

Muralidharan A, Thiagarajan K, Van Ham R, Gleason TG, Mulukutla S, Schindler JT et al (2016) Meta-analysis of perioperative stroke and mortality in transcatheter aortic valve implantation. Am J Cardiol 118(7):1031–1045PubMed

14.

Andersen ND, Hart SA, Devendra GP, Kim ESH, Johnston DR, Schroder JN et al (2018) Atheromatous disease of the aorta and perioperative stroke. J Thorac Cardiovasc Surg 155(2):508–516PubMed

15.

Imasaka K‑I, Tayama E, Tomita Y (2017) The impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery. J Thorac Cardiovasc Surg 153(5):1045–1053PubMed

16.

Bennett KM, Scarborough JE, Shortell CK (2015) Predictors of 30-day postoperative stroke or death after carotid endarterectomy using the 2012 carotid endarterectomy-targeted American college of surgeons national surgical quality improvement program database. J Vasc Surg 61(1):103–111PubMed

17.

Bucerius J, Gummert JF, Borger MA, Walther T, Doll N, Onnasch JF et al (2003) Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients. Ann Thorac Surg 75(2):472–478PubMed

18.

Rocha RV, Lindsay TF, Friedrich JO, Shan S, Sinha S, Yanagawa B et al (2020) Systematic review of contemporary outcomes of endovascular and open thoracoabdominal aortic aneurysm repair. J Vasc Surg 71(4):1396–1412.e12PubMed

19.

Sharifpour M, Moore LE, Shanks AM, Didier TJ, Kheterpal S, Mashour GA (2013) Incidence, predictors, and outcomes of perioperative stroke in noncarotid major vascular surgery. Anesth Analg 116(2):424–434PubMed

20.

Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MMB (2003) Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med 348(13):1215–1222PubMed

21.

NeuroVISION Investigators (2019) Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study. Lancet 394(10203):1022–1029

22.

Lewis DJ, Al-Ghazawi SS, Al-Robaidi KA, Thirumala PD (2019) Perioperative stroke associated in-hospital morbidity and in-hospital mortality in common non-vascular non-neurological surgery. J Clin Neurosci 67:32–39PubMed

23.

Thiagarajan K, Jeevanantham V, Van Ham R, Gleason TG, Badhwar V, Chang Y et al (2017) Perioperative stroke and mortality after surgical aortic valve replacement: a meta-analysis. Neurologist 22(6):227–233PubMed

24.

Leitlinien für Diagnostik und Therapie in der Neurologie: Akuttherapie des ischämischen Schlaganfalls – Ergänzung 2015 – Rekanalisierende Therapie. https://www.dgn.org/leitlinien/3198-030-140-rekanalisierende-therapie-ergaenzungakuttherapie-schlaganfall. Zugegriffen: 30.07.2020

25.

Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke 24(1):35–41PubMed

26.

Pai S‑L, Wang RD, Aniskevich S (2017) Perioperative stroke: incidence, etiologic factors, and prevention. Minerva Anestesiol 83(11):1178–1189PubMed

27.

Selim M (2007) Perioperative stroke. N Engl J Med 356(7):706–713PubMed

28.

Likosky DS, Marrin CAS, Caplan LR, Baribeau YR, Morton JR, Weintraub RM et al (2003) Determination of etiologic mechanisms of strokes secondary to coronary artery bypass graft surgery. Stroke 34(12):2830–2834PubMed

29.

DeFoe GR, Dame NA, Farrell MS, Ross CS, Langner CW, Likosky DS (2014) Embolic activity during in vivo cardiopulmonary bypass. J Extra Corpor Technol 46(2):150–156PubMedPubMedCentral

30.

Lin M‑H, Kamel H, Singer DE, Wu Y‑L, Lee M, Ovbiagele B (2019) Perioperative/postoperative atrial fibrillation and risk of subsequent stroke and/or mortality. Stroke 50(6):1364–1371PubMed

31.

Tsuda K, Shiiya N, Washiyama N, Yamashita K, Ohkura K, Takahashi D et al (2018) Carotid stenosis with impaired brain flow reserve is associated with an increased risk of stroke in on-pump cardiovascular surgery. Interact CardioVasc Thorac Surg 27(1):75–80PubMed

32.

Torvik A (1984) The pathogenesis of watershed infarcts in the brain. Stroke 15(2):221–223PubMed

33.

McEvoy MD, Gupta R, Koepke EJ, Feldheiser A, Michard F, Levett D et al (2019) Perioperative quality initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery, S 575–586

34.

Chan MTV, Wang CY, Seet E, Tam S, Lai HY, Chew EFF et al (2019) Association of unrecognized obstructive sleep apnea with postoperative cardiovascular events in patients undergoing major noncardiac surgery. JAMA 321(18):1788–1798PubMedPubMedCentral

35.

Filsoufi F, Rahmanian PB, Castillo JG, Bronster D, Adams DH (2008) Incidence, imaging analysis, and early and late outcomes of stroke after cardiac valve operation. Am J Cardiol 101(10):1472–1478PubMed

36.

Filsoufi F, Rahmanian PB, Castillo JG, Bronster D, Adams DH (2008) Incidence, topography, predictors and long-term survival after stroke in patients undergoing coronary artery bypass grafting. Ann Thorac Surg 85(3):862–870PubMed

37.

Gialdini G, Nearing K, Bhave PD, Bonuccelli U, Iadecola C, Healey JS et al (2014) Perioperative atrial fibrillation and the long-term risk of ischemic stroke. JAMA 312(6):616–622PubMedPubMedCentral

38.

Moore LE, Sferra JJ, Engoren M (2020) Timing and risk factors associated with postoperative stroke in vascular surgery patients using time-varying coefficients from a Cox model. Anesth Analg 130(3):673–684PubMed

39.

Ng PY, Ng AK‑Y, Subramaniam B, Burns SM, Herisson F, Timm FP et al (2018) Association of preoperatively diagnosed patent foramen ovale with perioperative ischemic stroke. JAMA 319(5):452–462PubMedPubMedCentral

40.

Jørgensen ME, Torp-Pedersen C, Gislason GH, Jensen PF, Berger SM, Christiansen CB et al (2014) Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 312(3):269–277PubMed

41.

Christiansen MN, Andersson C, Gislason GH, Torp-Pedersen C, Sanders RD, Føge Jensen P et al (2017) Risks of cardiovascular adverse events and death in patients with previous stroke undergoing emergency noncardiac, nonintracranial surgery: the importance of operative timing. Anesthesiology 127(1):9–19PubMed

42.

Tsai W‑C, Lin H‑C, Lai Y‑R, Hsu C‑W, Huang C‑C, Wang H‑C et al (2019) The effect of stroke subtypes on baroreceptor sensitivity, a predict for acute stroke outcome. Biomed Res Int 2019(6):7614828–7614829PubMedPubMedCentral

43.

Sanders RD, Jørgensen ME, Mashour GA (2015) Perioperative stroke: a question of timing? Br J Anaesth 115(1):11–13PubMed

44.

Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Deutsche Gesellschaft für Innere Medizin (DGIM), Deutsche Gesellschaft für Chirurgie (DGCH), Zwissler B (2017) Preoperative evaluation of adult patients before elective, noncardiothoracic surgery : joint recommendation of the German society of anesthesiology and intensive care medicine, the German society of surgery, and the German society of internal medicine. Anaesthesist 66:442–458

45.

Mashour GA, Moore LE, Lele AV, Robicsek SA, Gelb AW (2014) Perioperative care of patients at high risk for stroke during or after non-cardiac, non-neurologic surgery: consensus statement from the society for neuroscience in anesthesiology and critical care*. J Neurosurg Anesthesiol 26(4):273–285. https://doi.org/10.1097/ANA.0000000000000087CrossRefPubMed

46.

Minhas JS, Rook W, Panerai RB, Hoiland RL, Ainslie PN, Thompson JP et al (2020) Pathophysiological and clinical considerations in the perioperative care of patients with a previous ischaemic stroke: a multidisciplinary narrative review. Br J Anaesth 124(2):183–196PubMed

47.

Lewis SR, Pritchard MW, Schofield-Robinson OJ, Alderson P, Smith AF (2018) Continuation versus discontinuation of antiplatelet therapy for bleeding and ischaemic events in adults undergoing non-cardiac surgery. Cochrane Database Syst Rev 7(2):CD12584PubMed

48.

Endres M, Diener H‑C, Behnke M, Röther J (2015) Sekundärprophylaxe ischämischer Schlaganfall und transitorische ischämische Attacke (Teil 1). Leitlinien für Diagnostik und Therapie in der Neurologie

49.

Plümer L, Seiffert M, Punke MA, Kersten JF, Blankenberg S, Zöllner C et al (2017) Aspirin before elective surgery-stop or continue? Dtsch Arztebl Int 114(27–28):473–480PubMedPubMedCentral

50.

Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D et al (2018) Perioperative beta-blockers for preventing surgery-related mortality and morbidity. Cochrane Database Syst Rev 3(4):CD4476PubMed

51.

Hajibandeh S, Antoniou SA, Torella F, Antoniou GA (2017) Effect of beta-blockers on perioperative outcomes in vascular and endovascular surgery: a systematic review and meta-analysis. Br J Anaesth 118(1):11–21PubMed

52.

Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD et al (2014) 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European society of cardiology (ESC) and the European society of anaesthesiology (ESA. Eur Heart J 35:2383–2431PubMed

53.

POISE Study Group, Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K et al (2008) Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet 371(9627):1839–1847

54.

Blessberger H, Lewis SR, Pritchard MW, Fawcett LJ, Domanovits H, Schlager O et al (2019) Perioperative beta-blockers for preventing surgery-related mortality and morbidity in adults undergoing non-cardiac surgery. Cochrane Database Syst Rev 9(1):CD13438PubMed

55.

Hajibandeh S, Antoniou SA, Torella F, Antoniou GA (2018) Meta-analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy. Anaesthesia 73(10):1280–1289PubMed

56.

Mukherjee D, Collins DT, Liu C, Ha N, Jim J (2020) The study of transcarotid artery revascularization under local versus general anesthesia with results from the society for vascular surgery vascular quality initiative. Vascular 54:1708538120924158

57.

Vaniyapong T, Chongruksut W, Rerkasem K (2013) Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev 4(12):CD126

58.

Broos PPHL, Stokmans RA, Cuypers PWM, van Sambeek MRHM, Teijink JAW, ENGAGE Investigators (2015) Effects of anesthesia type on perioperative outcome after endovascular aneurysm repair. J Endovasc Ther 22(5):770–777PubMed

59.

Cheng M, Chen Q, Tran-McCaslin M, Chun L, Lew W, Patel K (2019) Endovascular abdominal aortic aneurysm repair: does anesthesia type matter? Ann Vasc Surg 61:284–290PubMed

60.

Villablanca PA, Mohananey D, Nikolic K, Bangalore S, Slovut DP, Mathew V et al (2018) Comparison of local versus general anesthesia in patients undergoing transcatheter aortic valve replacement: a meta-analysis. Catheter Cardiovasc Interv 91(2):330–342PubMed

61.

Husser O, Fujita B, Hengstenberg C, Frerker C, Beckmann A, Möllmann H et al (2018) Conscious sedation versus general anesthesia in transcatheter aortic valve replacement: the German aortic valve registry. JACC Cardiovasc Interv 11(6):567–578PubMed

62.

Memtsoudis SG, Sun X, Chiu Y‑L, Stundner O, Liu SS, Banerjee S et al (2013) Perioperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology 118(5):1046–1058PubMedPubMedCentral

63.

Memtsoudis SG, Cozowicz C, Bekeris J, Bekere D, Liu J, Soffin EM et al (2019) Anaesthetic care of patients undergoing primary hip and knee arthroplasty: consensus recommendations from the international consensus on anaesthesia-related outcomes after surgery group (ICAROS) based on a systematic review and meta-analysis. Br J Anaesth 123(3):269–287. https://doi.org/10.1016/j.bja.2019.05.042CrossRefPubMedPubMedCentral

64.

Sibon I, Orgogozo J‑M (2004) Antiplatelet drug discontinuation is a risk factor for ischemic stroke. Neurology 62(7):1187–1189PubMed

65.

Iadecola C (2017) The neurovascular unit coming of age: a journey through neurovascular coupling in health and disease. Neuron 96(1):17–42PubMedPubMedCentral

66.

Slupe AM, Kirsch JR (2018) Effects of anesthesia on cerebral blood flow, metabolism, and neuroprotection. J Cereb Blood Flow Metab 38(12):2192–2208PubMedPubMedCentral

67.

Brinjikji W, Murad MH, Rabinstein AA, Cloft HJ, Lanzino G, Kallmes DF (2015) Conscious sedation versus general anesthesia during endovascular acute ischemic stroke treatment: a systematic review and meta-analysis. AJNR Am J Neuroradiol 36(3):525–529PubMed

68.

Theilen HJ, Gerber JC (2019) Anesthesiological management in endovascular stroke treatment. Anaesthesist 68(11):733–741PubMed

69.

Schönenberger S, Hendén PL, Simonsen CZ, Uhlmann L, Klose C, Pfaff JAR et al (2019) Association of general anesthesia vs procedural sedation with functional outcome among patients with acute ischemic stroke undergoing thrombectomy: a systematic review and meta-analysis. JAMA 322(13):1283–1293PubMedPubMedCentral

70.

Diprose WK, Wang MTM, Campbell D, Sutcliffe JA, McFetridge A, Chiou D et al (2019) Intravenous propofol versus volatile anesthetics for stroke endovascular thrombectomy. J Neurosurg Anesthesiol. https://doi.org/10.1097/ANA.0000000000000639CrossRef

71.

Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA (2018) Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth 121(4):706–721PubMed

72.

Sun LY, Chung AM, Farkouh ME, van Diepen S, Weinberger J, Bourke M et al (2018) Defining an intraoperative hypotension threshold in association with stroke in cardiac surgery. Anesthesiology 129(3):440–447PubMed

73.

Howell SJ (2019) Consensus statements and expert guidance: interpret with care. Br J Anaesth 122(6):719–722PubMed

74.

Saugel B, Reese PC, Sessler DI, Burfeindt C, Nicklas JY, Pinnschmidt HO et al (2019) Automated ambulatory blood pressure measurements and Intraoperative hypotension in patients having noncardiac surgery with general anesthesia: a prospective observational study. Anesthesiology 131(1):74–83PubMed

75.

Zweifel C, Dias C, Smielewski P, Czosnyka M (2014) Continuous time-domain monitoring of cerebral autoregulation in neurocritical care. Med Eng Phys 36(5):638–645PubMed

76.

Xiong L, Liu X, Shang T, Smielewski P, Donnelly J, Guo Z‑N et al (2017) Impaired cerebral autoregulation: measurement and application to stroke. J Neurol Neurosurg Psychiatry 88(6):520–531PubMed

77.

Meng L, Gelb AW (2015) Regulation of cerebral autoregulation by carbon dioxide. Anesthesiology 122(1):196–205PubMed

78.

Joshi B, Ono M, Brown C, Brady K, Easley RB, Yenokyan G et al (2012) Predicting the limits of cerebral autoregulation during cardiopulmonary bypass. Anesth Analg 114(3):503–510PubMed

79.

Brown CH, Neufeld KJ, Tian J, Probert J, Laflam A, Max L et al (2019) Effect of targeting mean arterial pressure during cardiopulmonary bypass by monitoring cerebral autoregulation on postsurgical delirium among older patients: a nested randomized clinical trial. JAMA Surg 154(9):819–826PubMedPubMedCentral

80.

Vlisides PE, Kunkler B, Thompson A, Zierau M, Lobo R, Strasser MO et al (2019) Cerebrovascular disease and perioperative neurologic vulnerability: a prospective cohort study. Front Neurol 10:560PubMedPubMedCentral

81.

Yu Y, Zhang K, Zhang L, Zong H, Meng L, Han R (2018) Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults. Cochrane Database Syst Rev 1(6):CD10947PubMed

82.

Sakudo A (2016) Near-infrared spectroscopy for medical applications: current status and future perspectives. Clin Chim Acta 455:181–188PubMed

83.

Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M et al (2019) European stroke organisation (ESO)—European society for minimally invasive neurological therapy (ESMINT) guidelines on mechanical thrombectomy in acute Ischaemic strokeendorsed by stroke alliance for europe (SAFE). Eur Stroke J 4(1):6–12PubMedPubMedCentral

84.

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K et al (2018) 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 49:e46–e110PubMed

85.

Sun Z, Yue Y, Leung CCH, Chan MTV, Gelb AW, Study Group for Perioperative Stroke In China (POSIC) (2016) Clinical diagnostic tools for screening of perioperative stroke in general surgery: a systematic review. Br J Anaesth 116(3):328–338PubMed

86.

Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA (2003) Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke 34(1):71–76PubMed

87.

Brott T, Adams HP, Olinger CP, Marler JR, Barsan WG, Biller J et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20(7):864–870PubMed

88.

Tirschwell DL, Longstreth WT, Becker KJ, Gammans RE, Sabounjian LA, Hamilton S et al (2002) Shortening the NIH stroke scale for use in the prehospital setting. Stroke 33(12):2801–2806PubMed

89.

Whelley-Wilson CM, Newman GC (2004) A stroke scale for emergency triage. J Stroke Cerebrovasc Dis 13(6):247–253PubMed

90.

Kothari R, Hall K, Brott T, Broderick J (1997) Early stroke recognition: developing an out-of-hospital NIH stroke scale. Acad Emerg Med 4(10):986–990PubMed

91.

Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL (2000) Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS). Stroke 31(1):71–76PubMed

92.

Bray JE, Martin J, Cooper G, Barger B, Bernard S, Bladin C (2005) Paramedic identification of stroke: community validation of the melbourne ambulance stroke screen. Cerebrovasc Dis 20(1):28–33PubMed

93.

Nor AM, Davis J, Sen B, Shipsey D, Louw SJ, Dyker AG et al (2005) The recognition of stroke in the emergency room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol 4(11):727–734PubMed

94.

Chenkin J, Gladstone DJ, Verbeek PR, Lindsay P, Fang J, Black SE et al (2009) Predictive value of the Ontario prehospital stroke screening tool for the identification of patients with acute stroke. Prehosp Emerg Care 13(2):153–159PubMed

95.

Studnek JR, Asimos A, Dodds J, Swanson D (2013) Assessing the validity of the Cincinnati prehospital stroke scale and the medic prehospital assessment for code stroke in an urban emergency medical services agency. Prehosp Emerg Care 17(3):348–353PubMed

96.

Andsberg G, Esbjörnsson M, Olofsson A, Lindgren A, Norrving B, von Euler M (2017) PreHospital ambulance stroke test—pilot study of a novel stroke test. Scand J Trauma Resusc Emerg Med 25(1):37–36PubMedPubMedCentral

97.

Pérez de la Ossa N, Carrera D, Gorchs M, Querol M, Millán M, Gomis M et al (2014) Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke 45(1):87–91PubMed

98.

Murkin JM, Martzke JS, Buchan AM, Bentley C, Wong CJ (1995) A randomized study of the influence of perfusion technique and pH management strategy in 316 patients undergoing coronary artery bypass surgery. II. Neurologic and cognitive outcomes. J Thorac Cardiovasc Surg 110(2):349–362PubMed

Titel: Perioperativer Schlaganfall
verfasst von: PD Dr. M. Fischer
Dr. U. Kahl
Publikationsdatum: 04.08.2020
Verlag: Springer Medizin
Schlagwörter: Anästhetika
Apoplex
Anästhetika
Erschienen in: Die Anaesthesiologie / Ausgabe 1/2021
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI: https://doi.org/10.1007/s00101-020-00823-5

Passend zum Thema

Leitlinien-Update und neue Pocket-Leitlinie vorgestellt von Prof. Möllmann

Vorhofflimmern

Die neue Leitlinie zur Behandlung von Herzklappenerkrankungen der European Society of Cardiology (ESC) und der European Association for Cardio-Thoracic Surgery (EACTS) ist ab jetzt als deutschsprachige Pocket-Leitlinien abrufbar. Die wichtigsten Neuerungen des Updates finden Sie hier von Prof. Dr. Helge Möllmann aus Dortmund für Sie zusammengefasst.

Expertenrat: Wer profitiert vom Vorhofohr-Verschluss

Vorhofflimmern

Der interventionelle Verschluss des linken Vorhofohrs ist eine in den Leitlinien empfohlene Alternative zur oralen Antikoagulation bei Menschen mit Vorhofflimmern. Bei welchen Patientinnen und Patienten Sie konkret an diese Alternative denken sollten – dazu gibt Kardiologe PD Dr. Zisis Dimitriadis alltagstaugliche Tipps.

Abbott Structural Heart

Content Hub

Wir helfen Menschen mit Strukturellen Herzerkrankungen ihre Lebensqualität zu verbessern. Entdecken Sie unser einzigartiges Produktportfolio für ihre Patienten.

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2021

Kurzversion der 2. Auflage der deutsch-österreichischen S3-Leitlinie „Infarkt-bedingter Kardiogener Schock – Diagnose, Monitoring und Therapie“

„Hot Topics“ in der Anästhesiologie 2019/2020

Inflammation und perioperative Organdysfunktion

Wenn Notarzt und Telenotarzt gemeinsam Leben retten

Kliniksanitäter. Ein interprofessionelles Blended-Learning-Konzept zur Weiterqualifikation von Rettungsdienst- und medizinischem Personal zum Einsatz auf Intensivstationen und in Notaufnahmen während der COVID-19-Pandemie

Was ist neu … Einsatz von künstlicher Intelligenz in der Intensivmedizin

Passend zum Thema

Leitlinien-Update und neue Pocket-Leitlinie vorgestellt von Prof. Möllmann

Expertenrat: Wer profitiert vom Vorhofohr-Verschluss

Abbott Structural Heart