Neuraxial anesthesia for non-neurological
emergency surgery in a patient with acute
ischemic stroke: a case report

Neuraxial anesthesia for non-neurological
emergency surgery in a patient with acute
ischemic stroke: a case report

Emergency surgery, Neuraxial anesthesia, Stroke

Abstract
Background The recent guidelines recommend delaying elective non-neurological surgery after an index stroke,
but there is a lack of consensus regarding emergency surgery in patients with a recent stroke. Impaired cerebral
autoregulation and altered baroreceptor function elevate the risk of recurrent stroke in this group. Moreover, the
impact of anesthesia type (general vs. regional) for non-cardiovascular, non-neurological surgery in patients with an
index stroke remains inconclusive.
Case presentation A 67-year-old male with an acute mild ischemic stroke underwent emergency surgery for an
obstructed right-sided direct inguinal hernia under combined spinal-epidural anesthesia. Pre-operative assessment
showed stable hemodynamics, and perioperative measures were taken to ensure stable blood pressure. Neuraxial
anesthesia was employed successfully, and the patient remained hemodynamically stable throughout the surgery
and postoperative period. No neurological deficits were observed post-surgery, and follow-up up to 3 months
revealed no cognitive impairment or neurological decline.

Conclusions Neuraxial anesthesia can be considered for patients with acute mild strokes requiring urgent non-
neurological surgery, provided they are hemodynamically stable and without coagulopathy. However, the choice of

anesthesia should be individualized based on factors such as neurological status, stroke severity, coagulation, and
existing disabilities. This case highlights the importance of a personalized approach to anesthesia in emergency
surgery for stroke patients.
Keywords Emergency surgery, Neuraxial anesthesia, Stroke

Asish Subedi1* and Ashok Gautam1

https://doi.org/10.1186/s12245-024-00687-1

2024

Peri Irawan

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