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 - 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 -