Advertisement

Nurse's Role in Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery

      Abstract

      Perioperative nurses have the opportunity to play a key role in prevention and recognition of stroke in patients undergoing noncardiac, nonneurological surgery and may impact this potentially devastating complication. Effective nursing care of the older adult requires a specialized knowledge base. Scientific Statements are a cornerstone of the knowledge base that informs this care. This article summarizes the recently released American Heart Association/American Stroke Association Scientific Statement entitled: Perioperative Neurological Evaluation and Management to Lower the Risk of Acute Stroke in Patients Undergoing Noncardiac, Nonneurological Surgery and discusses the nurse's role in the care of this vulnerable patient population.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of PeriAnesthesia Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. ASPAN Position Statement 5. American Society of Perianesthesia Nurses. A position statement on the older adult perianesthesia nursing standards. 2021 Practice Recommendations and Interpretive Statements. Accessed November 15, 2021 https://www.aspan.org/Portals/88/Clinical%20Practice/Position%20Statements/Current/PS_5.pdf?ver=2021-01-12-153625-597

        • Benesch C
        • Glance LG
        • Derdeyn CP
        • et al.
        Perioperative neurological evaluation and management to lower the risk of acute stroke in patients undergoing noncardiac, nonneurological surgery: a scientific statement from the American Heart Association/American Stroke Association.
        Circulation. 2021; 143: e1-e24https://doi.org/10.1161/CIR.0000000000000968
        • Gaudino M
        • Benesch C
        • Bakaeen F
        • et al.
        Considerations for reduction of risk of perioperative stroke in adult patients undergoing cardiac and thoracic aortic operations: a statement from the American Heart Association.
        Circulation. 2020; 142: e193-e209https://doi.org/10.1161/CIR.00000000000000885
        • Filla S.
        • Davis G.
        Stroke center readiness in the PACU.
        J Perianesth Nurs. 2015; 30: e14-e15
        • Wente S
        • Gingerich SD
        Partnership through integration: perianesthesia policy standardization.
        J Perianesth Nurs. 2021; 36: 116-121https://doi.org/10.1016/j.jopan.2020.08.012
      2. American College of Surgeons Surgical Risk Calculator. Accessed August 8, 2021 https://riskcalculator.facs.org/RiskCalculator/PatientInfo.jsp

        • Fleisher LA
        • Fleischmann KE
        • Auerbach AD
        • et al.
        2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2014; 130: e278-e333https://doi.org/10.1161/CIR.0000000000000106
        • Lee TH
        • Marcantonio ER
        • Mangione CM
        • et al.
        Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery.
        Circulation. 1999; 100: 1043-1049https://doi.org/10.1161/01.cir.100.10.1043
        • January CT
        • Wann LS
        • Alpert JS
        • et al.
        2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society.
        Circulation. 2014; 130 (Epub 2014 Mar 28. Erratum in: Circulation. 2014 Dec 2;130(23):e270-1. PMID: 24682348): 2071-2104https://doi.org/10.1161/CIR.0000000000000040
        • Pisters R
        • Lane DA
        • Nieuwlaat R
        • de Vos CB
        • Crijns HJ
        • Lip GY.
        A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey.
        Chest. 2010; 138 (Epub 2010 Mar 18PMID: 20299623): 1093-1100https://doi.org/10.1378/chest.10-0134
        • Hornor MA
        • Duane TM
        • Ehlers AP
        • et al.
        American College of Surgeons’ Guidelines for the perioperative management of antithrombotic medication.
        J Am Coll Surg. 2018; 227 (521–536 e1)https://doi.org/10.1016/j.jamcollsurg.2018.08.183
        • Collins-Yoder A
        • Collins RE.
        Periprocedural considerations for anticoagulated atrial fibrillation patients.
        J Perianesth Nurs. 2018; 34: 227-239https://doi.org/10.1016/j.jopan.2018.05.014
      3. Association of Perioperative Room Nurses. AORN position statement on care of the older adult in perioperative settings. 2015 Accessed November 15, 2021 https://aorn.org/guidelines/clinical-resources/position-statements

        • Devereaux PJ
        • Yang H
        • et al.
        • POISE Study Group
        Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomized controlled trial.
        Lancet. 2008; 371: 1839-1847https://doi.org/10.1016/S0140-6736(08)60601-7
        • Walsh M
        • Devereaux PJ
        • Garg AX
        • et al.
        Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension.
        Anesthesiology. 2013; 119: 507-515https://doi.org/10.1097/ALN.0b013e3182a10e26
        • Monk TG
        • Bronsert MR
        • Henderson WG
        • et al.
        Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery.
        Anesthesiology. 2015; 123: 307-319https://doi.org/10.1097/ALN.0000000000000756
        • Carson JL
        • Guyatt G
        • Heddle NM
        • et al.
        Clinical practice guidelines from the AABB: red blood cell transfusion thresholds and storage.
        JAMA. 2016; 316: 2025-2035https://doi.org/10.1001/jama.2016.9185
        • Futier E
        • Constantin JM
        • Paugam-Burtz C
        • et al.
        A trial of intraoperative low-tidal-volume ventilation in abdominal surgery.
        N Engl J Med. 2013; 369: 428-437https://doi.org/10.1056/NEJMoa1301082
        • Brower RG
        • Matthay MA
        • Morris A
        • et al.
        Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome.
        N Engl J Med. 2000; 342: 1301-1308https://doi.org/10.1056/NEJM200005043421801
        • Cumbler E
        • Wald H
        • Bhatt DL
        • et al.
        Quality of care and outcomes for in-hospital ischemic stroke: findings from the National Get With The Guidelines–Stroke.
        Stroke. 2014; 45: 231-238https://doi.org/10.1161/STROKEAHA.113.003617
        • Saltman AP
        • Silver FL
        • Fang J
        • Stamplecoski M
        • Kapral MK.
        Care and outcomes of patients with in-hospital stroke.
        JAMA Neurol. 2015; 72: 749-755https://doi.org/10.1001/jamaneurol.2015.0284
        • O'Driscoll L
        • Moore C
        • Bonds R.
        Identification and management of ischemic stroke in the postanesthesia care unit.
        J Perianesth Nurs. 2019; 34 (Epub 2019 Jun 14PMID:31204272): 881-888https://doi.org/10.1016/j.jopan.2019.01.011
        • Sun Z
        • Yue Y.
        • Leung C.C.H.
        • Chan M.T.V.
        • Gelb A.W.
        • on behalf of the Study Group for Perioperative Stroke In China (POSIC)
        Clinical diagnostic tools for screening of perioperative stroke in general surgery: a systematic review.
        Br J Anaesth. 2016; 116: 328-338https://doi.org/10.1093/bja/aev452
        • Kothari RU
        • Pancioli A
        • Liu T
        • Brott T
        • Broderick J.
        Cincinnati Prehospital Stroke Scale: reproducibility and validity.
        Ann Emerg Med. 1999; 33 (PMID:10092713): 373-378https://doi.org/10.1016/s0196-0644(99)70299-4
        • Jiang L
        • Douglas H.
        Respond, intervene and escalate: acute stroke events in the post anesthesia care unit.
        J Perianesth Nurs. 2019; 34: e15https://doi.org/10.1016/j.jopan.2019.05.043
        • Snavely J
        • Thompson H
        • Bridges EM.
        Impact of a structured response and evidence based checklist on in-hospital stroke outcomes.
        J Neurosci Nurs. 2020; 52: 136-142https://doi.org/10.1097/JNN.0000000000000508
        • Powers WJ
        • Rabinstein AA
        • Ackerson T
        • et al.
        Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association [published correction appears in Stroke. 2019;50:e440–e441].
        Stroke. 2019; 50: e344-e418https://doi.org/10.1161/STR.0000000000000211