Analysis of the prognostic value of emergency blood tests in ischaemic stroke.

OBJECTIVES: This study aims to evaluate the prognostic value of emergency blood test results in patients with acute ischaemic stroke. METHODS: We evaluated 592 prospectively patients with neuroimaging-confirmed ischaemic stroke admitted to our stroke unit between 2015 and 2018. We gathered emergency blood test results and calculated the neutrophil-to-lymphocyte ratio and the neutrophil-to-platelet ratio (neutrophils × 1.000/platelets). The association between blood test results and functional prognosis (as measured with the modified Rankin Scale) and such complications as haemorrhagic transformation was evaluated by logistic regression analysis. The additional predictive value of blood test parameters was assessed with receiver operating characteristic curves and the net reclassification index. RESULTS: An neutrophil-to-lymphocyte ratio ≥ 3 at admission was associated with a two-fold increase in the risk of functional dependence at 3 months (OR: 2.24; 95% CI: 1.35-3.71) and haemorrhagic transformation (OR: 2.11; 95% CI: 1.09-4.05), while an neutrophil-to-lymphocyte ratio ≥ 3.86 resulted in an increase of 2.4 times in the risk of mortality at 3 months (OR: 2.41; 95% CI: 1.37-4.26) after adjusting for the traditional predictors of poor outcomes. Patients with neutrophil-to-platelet ratio ≥ 32 presented 3 times more risk of haemorrhagic transformation (OR: 3.17; 95% CI: 1.70-5.92) and mortality at 3 months (OR: 3.07; 95% CI: 1.69-5.57). Adding these laboratory parameters to standard clinical-radiological models significantly improved discrimination and prognostic accuracy. CONCLUSIONS: Basic blood test parameters provide important prognostic information for stroke patients and should therefore be analysed in combination with standard clinical and radiological parameters to optimise ischaemic stroke management.

[Persistent supraventricular tachycardia after volatile inhalational anaesthetic induction with sevoflurane in a pediatric patient].

Inhaled anaesthetic induction with sevoflurane is very common in the pediatric population. Sevoflurane systemic effects are widely known, while not all the side effects are known. We present a four year-old child who developed a persistent supraventricular tachycardia after inhaled anaesthetic induction with sevoflurane. The arrhythmia did not end until sevoflurane was stopped and changed to an intravenous continuous perfusion of hypnotic drugs (propofol and remiphentanyl). The exact mechanism for such a causal relationship with sevoflurane administration is unknown, and possible diagnoses include atrioventricular nodal reentry tachycardia (AVNRT) and the existence of an accessory pathway. An episode of persistent supraventricular tachycardia with a clear causal relationship with sevoflurane administration is not found in the literature.

Taquicardia supraventricular sostenida tras inducción anestésica inhalatoria con sevoflurano en paciente pediátrico / Persistent supraventricular tachycardia after volatile inhalational anaesthetic induction with sevoflurane in a pediatric patient

La inducción anestésica inhalatoria con sevoflurano es muy empleada en la población pediátrica. Si bien los efectos sistémicos más comunes son ampliamente conocidos, no se conocen todos los efectos secundarios de este fármaco. Presentamos el caso clínico de un varón de cuatro años que desarrolló un episodio de taquicardia supraventricular sostenida tras la inducción anestésica con sevoflurano, que no cedió hasta que no se retiró el fármaco y se sustituyó el mantenimiento anestésico por una perfusión continua de fármacos hipnóticos intravenosos (propofol y remifentanilo). Desconocemos el mecanismo exacto por el que este episodio ha tenido una relación causal tan clara con la administración de sevoflurano; las posibilidades diagnósticas serían la taquicardia por reentrada intranodal o la existencia de una vía accesoria. No hemos encontrado en la literatura un episodio de taquicardia supraventricular mantenida con una relación causal directa con la administración de sevoflurano como en el caso que presentamos.(AU)

Inhaled anaesthetic induction with sevoflurane is very common in the pediatric population. Sevoflurane systemic effects are widely known, while not all the side effects are known. We present a four year-old child who developed a persistent supraventricular tachycardia af-ter inhaled anaesthetic induction with sevoflurane. The arrhythmia did not end until sevoflurane was stopped and changed to an intravenous continuous perfusion ofhypnotic drugs (propofol and remiphentanyl). The exact mechanism for such a causal relationship with sevoflurane administration is unknown, and possible diagnoses include atrioventricular nodal reentry tachycardia (AVNRT) and the existence of an accessory pathway. An episode of persistent supraventricular tachycardia with a clear causal relationship with sevoflurane administration is not found in the literature.(AU)