TY - JOUR
T1 - Effects of volatile anesthetics on postoperative ischemic stroke incidence
AU - Raub, Dana
AU - Platzbecker, Katharina
AU - Grabitz, Stephanie D.
AU - Xu, Xinling
AU - Wongtangman, Karuna
AU - Pham, Stephanie B.
AU - Murugappan, Kadhiresan R.
AU - Hanafy, Khalid A.
AU - Nozari, Ala
AU - Houle, Timothy T.
AU - Kendale, Samir M.
AU - Eikermann, Matthias
N1 - Funding Information:
This work was supported by Philanthropic Donors Jeffrey and Judy Buzen in an unrestricted grant to Matthias Eikermann. The funders had no role in the design or conduct of the study; the handling of data; the preparation of the manuscript, or the decision to submit it for publication.
Publisher Copyright:
© 2021 The Authors.
PY - 2021
Y1 - 2021
N2 - BACKGROUND: Preclinical studies suggest that volatile anesthetics decrease infarct volume and improve the outcome of is-chemic stroke. This study aims to determine their effect during noncardiac surgery on postoperative ischemic stroke incidence. METHODS AND RESULTS: This was a retrospective cohort study of surgical patients undergoing general anesthesia at 2 tertiary care centers in Boston, MA, between October 2005 and September 2017. Exclusion criteria comprised brain death, age <18 years, cardiac surgery, and missing covariate data. The exposure was defined as median age-adjusted minimum alveolar concentration of all intraoperative measurements of desflurane, sevoflurane, and isoflurane. The primary outcome was postoperative ischemic stroke within 30 days. Among 314 932 patients, 1957 (0.6%) experienced the primary outcome. Higher doses of volatile anesthetics had a protective effect on postoperative ischemic stroke incidence (adjusted odds ratio per 1 minimum alveolar concentration increase 0.49, 95% CI, 0.40–0.59, P<0.001). In Cox proportional hazards regression, the effect was observed for 17 postoperative days (postoperative day 1: hazard ratio (HR), 0.56; 95% CI, 0.48–0.65; versus day 17: HR, 0.85; 95% CI, 0.74–0.99). Volatile anesthetics were also associated with lower stroke severity: Every 1-unit increase in minimum alveolar concentration was associated with a 0.006-unit decrease in the National Institutes of Health Stroke Scale (95% CI, −0.01 to −0.002, P=0.002). The effects were robust throughout various sensitivity analyses including adjustment for anesthesia providers as random effect. CONCLUSIONS: Among patients undergoing noncardiac surgery, volatile anesthetics showed a dose-dependent protective effect on the incidence and severity of early postoperative ischemic stroke.
AB - BACKGROUND: Preclinical studies suggest that volatile anesthetics decrease infarct volume and improve the outcome of is-chemic stroke. This study aims to determine their effect during noncardiac surgery on postoperative ischemic stroke incidence. METHODS AND RESULTS: This was a retrospective cohort study of surgical patients undergoing general anesthesia at 2 tertiary care centers in Boston, MA, between October 2005 and September 2017. Exclusion criteria comprised brain death, age <18 years, cardiac surgery, and missing covariate data. The exposure was defined as median age-adjusted minimum alveolar concentration of all intraoperative measurements of desflurane, sevoflurane, and isoflurane. The primary outcome was postoperative ischemic stroke within 30 days. Among 314 932 patients, 1957 (0.6%) experienced the primary outcome. Higher doses of volatile anesthetics had a protective effect on postoperative ischemic stroke incidence (adjusted odds ratio per 1 minimum alveolar concentration increase 0.49, 95% CI, 0.40–0.59, P<0.001). In Cox proportional hazards regression, the effect was observed for 17 postoperative days (postoperative day 1: hazard ratio (HR), 0.56; 95% CI, 0.48–0.65; versus day 17: HR, 0.85; 95% CI, 0.74–0.99). Volatile anesthetics were also associated with lower stroke severity: Every 1-unit increase in minimum alveolar concentration was associated with a 0.006-unit decrease in the National Institutes of Health Stroke Scale (95% CI, −0.01 to −0.002, P=0.002). The effects were robust throughout various sensitivity analyses including adjustment for anesthesia providers as random effect. CONCLUSIONS: Among patients undergoing noncardiac surgery, volatile anesthetics showed a dose-dependent protective effect on the incidence and severity of early postoperative ischemic stroke.
KW - Anesthetics
KW - Cerebral ischemia
KW - Retrospective studies
KW - Stroke
KW - Stroke prevention
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U2 - 10.1161/JAHA.120.018952
DO - 10.1161/JAHA.120.018952
M3 - Article
C2 - 33634705
AN - SCOPUS:85102536541
SN - 2047-9980
VL - 10
SP - 1
EP - 44
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 5
M1 - e018952
ER -