#266 Protecting the Brain: Perioperative Stroke Prevention

Perioperative stroke represents a rare but potentially devastating complication of anesthesia care. While occurring in less than 1% of non-cardiac surgical patients, this complication fundamentally threatens not just patient outcomes but their very identity. As Dr. Jacob Nadler poignantly notes in our podcast, "By maintaining brain health, we're preserving the essence of who our patients are—their memories, their personality, their ability to connect with friends and family."The most significant recent development in this field comes from the 2024 joint guidelines that have dramatically shortened the recommended waiting period following stroke before elective surgery. What was once a nine-month wait has been reduced to just three months based on compelling evidence from a cohort study of 5.8 million patients showing risk stabilization after 90 days. This change has profound implications for surgical planning and patient care timelines.Anesthesia professionals must be vigilant about key risk factors including advanced age, previous stroke history, renal dysfunction, and anemia. The podcast explores critical medication management considerations, particularly regarding anticoagulation protocols, alongside specific intraoperative targets for blood pressure and hemoglobin levels. For suspected perioperative stroke, rapid multidisciplinary intervention with emergent brain imaging, possible thrombolytics, and mechanical thrombectomy may be indicated.For every anesthesia professional, this episode provides essential insights to help fulfill our commitment that no one shall be harmed by anesthesia care. Subscribe on Spotify or YouTube and share with colleagues to spread this vital safety information.For show notes & transcript, visit our episode page at apsf.org: https://www.apsf.org/podcast/266-protecting-the-brain-perioperative-stroke-prevention/© 2025, The Anesthesia Patient Safety Foundation

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