Pulse pressure and perioperative stroke

Research output: Contribution to journalArticle

Abstract

PURPOSE OF REVIEW: Central pulse pressure (PP), a marker of vascular stiffness, is a novel indicator of risk for perioperative morbidity including ischemic stroke. Appreciation for the mechanism by which vascular stiffness leads to organ dysfunction along with understanding its clinical detection may lead to improved patient management. RECENT FINDINGS: Vascular stiffness is associated with increased mortality and neurologic, cardiac, and renal injury in nonsurgical and surgical patients. Left ventricular hypertrophy and diastolic dysfunction along with microcirculatory changes in the low vascular resistance, high blood flow, cerebral and renal vasculature are seen in patients with vascular stiffness. Pulse wave velocity and the augmentation index have higher sensitivity for detecting of vascular stiffness than peripheral PP as the hemodynamic consequences of vascular stiffness are secondary to alterations in the central vasculature. Vascular stiffness alters cerebral autoregulation, resulting in a high likelihood of having a lower limit of autoregulation more than 65 mmHg during surgery. Vascular stiffness may predispose to cerebral hypoperfusion, increasing vulnerability to ischemic stroke, postoperative delirium, and acute kidney injury. SUMMARY: Vascular stiffness leads to alterations in cerebral, cardiac, and renal hemodynamics increasing the risk of perioperative ischemic stroke and neurologic, cardiac, and renal dysfunction.

Original languageEnglish (US)
Pages (from-to)57-63
Number of pages7
JournalCurrent opinion in anaesthesiology
Volume32
Issue number1
DOIs
StatePublished - Feb 1 2019

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Vascular Stiffness
Stroke
Blood Pressure
Kidney
Nervous System
Cerebrovascular Circulation
Homeostasis
Hemodynamics
Pulse Wave Analysis
Delirium
Renal Circulation
Left Ventricular Hypertrophy
Acute Kidney Injury
Vascular Resistance
Morbidity
Mortality

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

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Pulse pressure and perioperative stroke. / Al-Qamari, Abbas; Adeleke, Ibukunoluwa Oluwayemisi; Kretzer, Adam Blaine; Hogue, Charles Wallace.

In: Current opinion in anaesthesiology, Vol. 32, No. 1, 01.02.2019, p. 57-63.

Research output: Contribution to journalArticle

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