Accidents vasculaires cérébraux périopératoires

Resume La periode perioperatoire est une periode a risque de complications vasculaires cerebrales et notamment ischemiques. L’inflammation systemique liee au stress chirurgical et anesthesique est responsable d’un etat d’hypercoagulabilite, favorisant la complication thromboembolique. L’âge, l’insuffisance renale et l’antecedent d’AVC ou d’AIT sont des facteurs de risques d’accident vasculaire cerebral postoperatoire. Le diagnostic d’AVC est suspecte devant tout retard de reveil ou signe de localisation neurologique. Differentes echelles sont disponibles telles que l’echelle de ROSIER ou le NIHSS pour guider le praticien. Tous les patients suspects d’AVC doivent beneficier d’une imagerie cerebrale en extreme urgence, afin tout d’abord de preciser la nature ischemique ou hemorragique de l’AVC, et l’imagerie de choix est l’IRM. En l’absence d’acces a l’IRM, un scanner sans injection sera realise. En cas de mise en evidence d’AVC ischemique a l’imagerie demandee en urgence, un avis neurovasculaire sera necessaire. Dans un deuxieme temps, une thrombectomie en urgence devra etre proposee avec si besoin transfert vers le centre responsable du secteur. Cette prise en charge necessite une organisation multidisciplinaire et la mise en place en amont d’une filiere de soins dediee. On associe a la thrombectomie des mesures d’optimisation du debit sanguin cerebral. Une strategie de prevention doit etre mise en place des que possible afin d’identifier les patients a risque des la consultation d’anesthesie, avec gestion des traitements antiagregants, anticoagulants et antiarythmiques. En peroperatoire, on adoptera des strategies de neuroprotection afin de favoriser la perfusion cerebrale via la gestion de l’hemodynamique, de la douleur, de la ventilation et de la glycemie.

• Publication year

  2020

• Venue

  Anesthésie & Réanimation

• Publication date

  2020-05-01

• Fields of study

  Not labeled

• Identifiers
  DOI 10.1016/j.anrea.2020.04.005
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar

• No claims are published for this paper.

• No concepts are published for this paper.

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