Cerebrovascular Accident Under Anesthesia During Dental Surgery

Stroke, or cerebrovascular accident (CVA), is a medical emergency that may lead to permanent neurological damage, complications, and death. The rapid loss of brain function due to disruption of the blood supply to the brain is caused by blockage (thrombosis, arterial embolism) or hemorrhage. The incidence of CVA during anesthesia for noncardiac nonvascular surgery is as high as 1% depending on risk factors. Comprehensive preoperative assessment and good perioperative management may prevent a CVA. However, should an ischemic event occur, appropriate and rapid management is necessary to minimize the deleterious effects caused to the patient. This case report describes a patient who had an ischemic CVA while under general anesthesia for dental alveolar surgery and discusses the anesthesia management.Key Words: General anesthesia, Cerebrovascular event, Complication, Dentistry.Central nervous system infarction occurs over a clinical spectrum.¹ A cerebrovascular accident (CVA), or stroke, is a sudden interruption in the blood supply to the brain, accompanied by overt signs.¹ Most strokes (85%) are caused by an abrupt occlusion of a cerebral artery leading to loss of adequate blood supply to a specific area of the brain (ischemic stroke).² Ischemic strokes are either thrombotic or embolic. A thrombotic stroke occurs when a blood clot (thrombus) forms in one of the arteries that supply blood to the brain.³ An embolic stroke occurs when a blood clot or other debris forms away from the brain and is carried through the bloodstream to lodge in narrower brain arteries. Another cause of stroke is when bleeding occurs into brain tissue from a ruptured blood vessel (hemorrhagic stroke).³Stroke is a leading cause of morbidity and mortality.⁴ Perioperative acute ischemic stroke is a recognized complication of noncardiac, nonvascular surgery.⁵ Among the general population, the rate of acute ischemic stroke in the perioperative period has been reported to be as high as 0.7%.⁵ The incidence increases to 1.0% as age increases above 65 years.⁵ Other major risk factors that predispose to acute ischemic stroke in the perioperative period include: renal disease, atrial fibrillation, previous history of stroke, valvular disease, congestive heart failure, male sex, diabetes mellitus, and race.^5–7Adequate preoperative assessment of risk is imperative.⁸ When possible, patients should receive optimum medical treatment in the interest of attenuating the impact of risk factors in the perioperative period.⁸ However, when strokes occur, rapid, immediate treatment is required to prevent permanent brain damage.⁹