ABSTRACT
Perioperative stroke is cerebral infarction occurring in the perioperative period.The incidence of perioperative stroke in non-cardiac,and non-neurologic surgery is about 0.7％,but the mortality can be as high as 26％ to 40％.The outcome of the patients with perioperative stroke can be disastrous.Here we report a case of perioperative ischemic stroke that occurred after surgery of lumbar decompression and pedical screw fixation.A 76-year-old female admitted to our hospital because of lumbar spinal stenosis.Her medical history included hypertension and diabetes for ten years.Her personal history included a smoking history of 60 years by 2 cigarettes per day,not quitting.Her carotid artery ultrasound showed multiple low echo plaques on the right side and multiple high echo plaques on the left side of the carotid artery,but without distinct stenosis.Other examinations and tests showed no distinct abnormality.She went on a lumbar decompression and pedical screw fixation uneventfully.The blood loss was 400 mL and autologous blood transfusion 150 mL.The arterial blood pressure (ABP) maintained during 100-130 mmHg/60-80 mmHg (1 mmHg =0.133 kPa).Sixty minutes after she recovered from general anesthesia,the patient developed symptoms of slurred speech and right limbs weakness.The anesthesiologist evaluated the patient immediately with National Institute of Health Stroke Scale (NIHSS).The NIHSS score was 11 and a stroke was highly suspected.The acute stroke team was therefore initiated and fast responded.Within 4 h,digital subtraction angiography (DSA) was proceeded,which showed the M1 segment of the left middle cerebral artery was occluded and the local stenosis of her right middle cerebral artery was up to 80％.After the successful embolectomy by Solitaire stent,the left middle cerebral artery reflowed and the forward blood flow was thrombolysis in myocardial infarction (TIMI) grade 3.The patient was discharged after 33 days after the surgery with a NIHSS of 9.Our case provides an example that an acute stroke team that included the department of anesthesiology can be beneficial to the patients' perioperative strokes.During the perioperative period,anesthesiologists should be included into the acute stroke team,because anesthesiologists and anesthesia nurses might be first observers of those early onset strokes.Our case also put forward this thought that a standard peri-operative stroke evaluation tool,like NIHSS,should be discussed and applied to facilitate and accelerate the initiation of perioperative acute stroke team.
ABSTRACT
Objective:To investigate the effect of general or regional anesthesia on postoperative cardiopulmonary complications and inpatient mortality after hip fracture surgery in elderly patients.Methods:A retrospective analysis was conducted according to the medical records of 572 elderly patients with hip fractures admitted to our hospital from January 1,2005 to December 31,2014.The age,gender,preoperative comorbidities,length of preoperative bedridden time,mechanism of injury,surgical types,anesthetic methods,major postoperative complications and inpatient mortality were recorded.Multivariate Logistic regression analysis was applied to analyze the impact of different anesthetic methods on inpatient mortality in these patients.Results:Of the 572 patients,392 (68.5％) received regional anesthesia.Inpatient death occurred in 8 (8/572,mortality:1.4％),including 5 cases of RA group (5/392,mortality:1.3％) and 3 cases of GA group (3/180,mortality:1.7％).There was no statistically significant difference between the two groups in inpatient mortality (P ＞ 0.05).Multiple Logistic regression analysis showed that gender (odds ratio:0.18,95％ CI:0.03-1.05,P =0.057),age (odds ratio:1.22,95％ CI:1.07-1.38,P =0.002),preoperative pulmonary comorbidities (odds ratio:12.09,95％ CI:2.28-64.12,P =0.003) and surgical types (odds ratio:9.36,95％ CI:1.34-64.26,P =0.024) were risk factors for inpatient mortality.Postoperative cardiovascular complications occurred in 36 patients (36/572,morbidity:6.3％),with 19 patients in RA group (19/392,morbidity:4.8％),and 17 patients in GA group (17/180,morbidity:9.4％).Multiple Logistic regression analysis showed that age (odds ratio:1.13,95％ CI:1.07-1.19,P ＜ 0.001),hypertension (odds ratio:2.72,95％ CI:1.24-5.96,P =0.012) and preoperative cerebral comorbidities (odds ratio:2.11,95％ CI:0.99-4.52,P =0.054) were risk factors for postoperative cardiovascular complications.Postoperative pulmonary complications occurred in 56 patients (56/572,morbidity:9.8％),with 19 patients in RA group (19/392,morbidity:4.8％),and 37 patients in GA group (37/180,morbidity:20.6％).Multiple Logistic regression analysis showed that age (odds ratio:1.13,95％ CI:1.07-1.19,P ＜0.001),preoperative pulmonary comorbidities (odds ratio:2.89,95％ CI:1.28-7.05,P=0.020),length of preoperative bedridden time (odds ratio:1.11,95％ CI:1.04-1.18,P =0.003) and anesthetic methods (odds ratio:5.86,95％ CI:2.98-11.53,P ＜ 0.001) were risk factors for postoperative pulmonary complications.Conclusion:General anesthesia may not affect the inpatient mortality after hip fracture surgery in elderly patients.Regional anesthesia is associated with a lower risk of pulmonary complications after surgical procedure compared with general anesthesia.