Forum für Wissenschaft, Industrie und Wirtschaft

Hauptsponsoren:     3M 
Datenbankrecherche:

 

Strokes associated with surgery can be devastating

12.02.2013
But prompt identification and outcomes can improve outcomes

Strokes that occur during or shortly after surgery can be devastating, resulting in longer hospital stays and increased risks of death or long-term disability.

But prompt identification and treatment of such strokes can improve neurologic outcomes, according to an article in the journal Expert Review of Neurotherapeutics by Loyola University Medical Center stroke specialists Sarkis Morales-Vidal, MD and Michael Schneck, MD.

The article answers commonly asked questions about the management of perioperative stroke. (A perioperative stroke is a stroke that occurs anytime between the time a patient is hospitalized for surgery until the patient is discharged from the hospital.)

Risk factors for peroperative stroke include advanced age, female gender, obesity, high blood pressure, smoking, peripheral vascular disease, chronic obstructive pulmonary disease, diabetes and high cholesterol. For most surgeries, the risk of perioperative stroke is less than 1 percent. But the risk can be as high as 5 percent for surgeries for head and neck tumors and between 2 and 10 percent for various heart surgeries.

The most common cause of perioperative stroke is blood clots. Blood thinners can reduce the risk of strokes, but can increase the risk of bleeding. Morales and Schneck write that in managing surgery patients, physicians must balance the risk of stroke versus the risk of significant bleeding complications. Studies have found that for many surgeries, including cardiovascular procedures, the benefits of giving patients aspirin (a blood thinner) outweigh the risks of bleeding.

The authors examine the evidence for several therapies to treat perioperative strokes caused by blood clots:

Intravenous clot-busting drug (rtPA). Because of the risk of bleeding, rtPA is not indicated for patients who have undergone major surgery within the previous 14 days. But rtPA probably is safe following minor surgeries such as muscle biopsies and dental procedures.

Delivering rtPA by catheter. In this procedure, a high concentration of the clot-busting drug is delivered by a catheter directly to the clot. But using this technique in any patient population, surgical or otherwise, "is not currently substantiated by randomized controlled trials," the authors write.

Mechanical clot busting. Catheter systems such as MERCI, Penumbra and Solitaire, which use mechanical devices to bust clots, have been deemed safe by the Food and Drug Administration. But these systems are "untested and unproven in perioperative stroke," Morales and Schneck write.

Ultrasound. Sonothrombolysis uses ultrasound to enhance the break-up of blood clots in the brain. "The evidence for sonothrombolysis in stroke is far from conclusive, and the perioperative population is unstudied," the authors write.

Hemicraniectomy. Large strokes can cause life-threatening brain swelling. A hemicraniectomy is surgery to relieve the swelling. The surgeon temporarily removes part of the skull, allowing the swollen brain to expand beyond the confines of the skull. "In appropriate cases, hemicraniectomy has shown clear benefit, improving survival and functional outcomes," Morales and Schneck write.

Morales is an assistant professor in the Department of Neurology of Loyola University Chicago Stritch School of Medicine. Schneck is a professor and medical director of the Neurosciences intensive care unit.

Jim Ritter | EurekAlert!
Further information:
http://www.lumc.edu

More articles from Health and Medicine:

nachricht Biofilm discovery suggests new way to prevent dangerous infections
23.05.2017 | University of Texas at Austin

nachricht Another reason to exercise: Burning bone fat -- a key to better bone health
19.05.2017 | University of North Carolina Health Care

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Orientierungslauf im Mikrokosmos

Physiker der Universität Würzburg können auf Knopfdruck einzelne Lichtteilchen erzeugen, die einander ähneln wie ein Ei dem anderen. Zwei neue Studien zeigen nun, welches Potenzial diese Methode hat.

Der Quantencomputer beflügelt seit Jahrzehnten die Phantasie der Wissenschaftler: Er beruht auf grundlegend anderen Phänomenen als ein herkömmlicher Rechner....

Im Focus: A quantum walk of photons

Physicists from the University of Würzburg are capable of generating identical looking single light particles at the push of a button. Two new studies now demonstrate the potential this method holds.

The quantum computer has fuelled the imagination of scientists for decades: It is based on fundamentally different phenomena than a conventional computer....

Im Focus: Tumult im trägen Elektronen-Dasein

Ein internationales Team von Physikern hat erstmals das Streuverhalten von Elektronen in einem nichtleitenden Material direkt beobachtet. Ihre Erkenntnisse könnten der Strahlungsmedizin zu Gute kommen.

Elektronen in nichtleitenden Materialien könnte man Trägheit nachsagen. In der Regel bleiben sie an ihren Plätzen, tief im Inneren eines solchen Atomverbunds....

Im Focus: Turmoil in sluggish electrons’ existence

An international team of physicists has monitored the scattering behaviour of electrons in a non-conducting material in real-time. Their insights could be beneficial for radiotherapy.

We can refer to electrons in non-conducting materials as ‘sluggish’. Typically, they remain fixed in a location, deep inside an atomic composite. It is hence...

Im Focus: Hauchdünne magnetische Materialien für zukünftige Quantentechnologien entwickelt

Zweidimensionale magnetische Strukturen gelten als vielversprechendes Material für neuartige Datenspeicher, da sich die magnetischen Eigenschaften einzelner Molekülen untersuchen und verändern lassen. Forscher haben nun erstmals einen hauchdünnen Ferrimagneten hergestellt, bei dem sich Moleküle mit verschiedenen magnetischen Zentren auf einer Goldfläche selbst zu einem Schachbrettmuster anordnen. Dies berichten Wissenschaftler des Swiss Nanoscience Institutes der Universität Basel und des Paul Scherrer Institutes in der Wissenschaftszeitschrift «Nature Communications».

Ferrimagneten besitzen zwei magnetische Zentren, deren Magnetismus verschieden stark ist und in entgegengesetzte Richtungen zeigt. Zweidimensionale, quasi...

Alle Focus-News des Innovations-reports >>>

Anzeige

Anzeige

IHR
JOB & KARRIERE
SERVICE
im innovations-report
in Kooperation mit academics
Veranstaltungen

Meeresschutz im Fokus: Das IASS auf der UN-Ozean-Konferenz in New York vom 5.-9. Juni

24.05.2017 | Veranstaltungen

Diabetes Kongress in Hamburg beginnt heute: Rund 6000 Teilnehmer werden erwartet

24.05.2017 | Veranstaltungen

Wissensbuffet: „All you can eat – and learn”

24.05.2017 | Veranstaltungen

 
VideoLinks
B2B-VideoLinks
Weitere VideoLinks >>>
Aktuelle Beiträge

Hochspannung für den Teilchenbeschleuniger der Zukunft

24.05.2017 | Physik Astronomie

3D-Graphen: Experiment an BESSY II zeigt, dass optische Eigenschaften einstellbar sind

24.05.2017 | Physik Astronomie

Optisches Messverfahren für Zellanalysen in Echtzeit - Ulmer Physiker auf der Messe "Sensor+Test"

24.05.2017 | Messenachrichten