Overview
Cerebrovascular accident (CVA) during surgery refers to an ischemic or hemorrhagic stroke occurring perioperatively, often due to embolic events, hemodynamic instability, or direct surgical trauma to cerebral vasculature 1.Diagnosis
Clinical signs of stroke (e.g., focal neurological deficits) post-operatively 1.
Imaging studies (CT or MRI) to differentiate ischemic from hemorrhagic stroke 1.
Electrocardiogram (ECG) and echocardiography to assess for cardiac sources of emboli 1.Management
Immediate stabilization including airway management and hemodynamic support 1.
Early neuroimaging to guide specific treatment (thrombolysis for ischemic CVA if eligible) 1.
Management of underlying causes (e.g., anticoagulation reversal, cardiac source identification) 1.Special Populations
Pregnancy: Limited specific guidance; focus on maternal and fetal monitoring post-CVA 1.
Pediatrics: Tailored neurological assessment and imaging techniques appropriate for pediatric patients 1.
Elderly: Consideration of comorbidities and frailty in treatment planning 1.
Comorbidities: Cardiac conditions warrant echocardiography to identify potential sources of emboli 1.Key Recommendations
Prompt recognition and imaging (CT/MRI) to differentiate stroke type and guide therapy (Evidence: Moderate 1).
Collaborative management between ENT surgeons and anesthesiologists to optimize airway and hemodynamic stability (Evidence: Expert opinion 1).
Evaluate and manage potential cardiac sources of emboli in patients with CVA during surgery (Evidence: Moderate 1).References
1 Liu A, Adekoya J. A history of the shared airway: anaesthesia in ENT. The Journal of laryngology and otology 2026. link
2 Vijendren A, Yung M, Sanchez J, Shiralkar U, Weigel L. An exploratory investigation of personality types attracted to ENT. The Journal of laryngology and otology 2016. link