Cerebrovascular disease is a major cause of morbidity and death.
Patients with a history of stroke, transient ischemic attacks (TIAs),
or asymptomatic extracranial vascular obstructions frequently present
to the operating room for unrelated procedures. This chapter discusses
a general approach to these patients as well as patients with other
common neurologic disorders. Chapter 21 discusses
anesthetic management of patients undergoing carotid artery surgery.
Nonvascular neurologic diseases and psychiatric disorders are
less frequently encountered in surgical patients and are often overlooked.
Fortunately, unless increased intracranial pressure (ICP) is present,
special anesthetic techniques are not usually required. Nonetheless,
the anesthesiologist must have a basic understanding of the major
neurologic and psychiatric disorders and their drug therapy; failure
to recognize potentially adverse anesthetic interactions may result
in avoidable perioperative morbidity.
The incidence of significant cerebrovascular disease in surgical
patients is unknown but increases with age. Patients with known
cerebrovascular disease typically have a history of TIAs or stroke. Asymptomatic
cervical bruits occur in up to 4% of patients over age
40 but do not necessarily indicate significant carotid artery obstruction.
Fewer than 10% of patients with completely asymptomatic
bruits have hemodynamically significant carotid artery lesions.
Moreover, the absence of a bruit does not exclude significant carotid
The risk of postoperative stroke ...