title: Challenges in the Anesthetic and Intensive Care Management of Acute Ischemic Stroke.
abstract: Acute ischemic stroke (AIS) is a devastating condition with high morbidity and mortality. In the past 2 decades, the treatment of AIS has been revolutionized by the introduction of several interventions supported by class I evidence-care on a stroke unit, intravenous tissue plasminogen activator within 4.5 hours of stroke onset, aspirin commenced within 48 hours of stroke onset, and decompressive craniectomy for supratentorial malignant hemispheric cerebral infarction. There is new class I evidence also demonstrating benefits of endovascular therapy on functional outcomes in those with anterior circulation stroke. In addition, the importance of the careful management of key systemic physiological variables, including oxygenation, blood pressure, temperature, and serum glucose, has been appreciated. In line with this, the role of anesthesiologists and intensivists in managing AIS has increased. This review highlights the main challenges in the endovascular and intensive care management of AIS that, in part, result from the paucity of research focused on these areas. It also provides guidelines for the management of AIS based upon current evidence, and identifies areas for further research.
authors.affiliation: *Neurocritical Care Unit, The National Hospital for Neurology and Neurosurgery, University College London Hospitals †NIHR University College London Hospitals Biomedical Research Centre, London, UK.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Kirkman
authors.forename: Simon
authors.initials: S
authors.lastname: Lambden
authors.forename: Martin
authors.initials: M
authors.lastname: Smith
mesh_terms: D000758:Anesthesia / Q000379:methods*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003422:Critical Care / Q000379:methods*; D056424:Decompressive Craniectomy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020521:Stroke / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D001241:Aspirin