Anesthetic management of a patient with ankylosing spondylitis and massive cerebral infarction undergoing transurethral resection of prostate and literatures review
LI Huibo1 SU Yuqi2 TAO Ruijiao2 LIANG Zhuofeng2 WU Hua2 CHEN Hanwen2 ZHANG Yiwen1
1.The First School of Clinical Medicine, Guangdong Medical University, Guangdong Province, Zhanjiang 524000, China;
2.Department of Anesthesiology, Shunde Hospital of Southern Medical University, Guangdong Province, Foshan 528000, China
Abstract：Patients with ankylosing spondylitis (AS) with severe cardiovascular and cerebrovascular diseases have a high risk of emergency airway, cardiovascular and cerebrovascular accidents during perioperative period, anesthesia management is difficult, but it is not well understood in clinical practice, and no related cases have been reported. This paper reports a case of AS complicated with massive cerebral infarction. The admitting diagnosis includes: Prostatic hyperplasia; Ankylosing spondylitis; Sequelae of cerebral infarction. Transurethral electrified resection of the prostate was performed under general anesthesia. Through perfect preoperative preparation, individual management of difficult airway and perioperative stroke prevention. The patient finally passed the perioperative period smoothly and was discharged successfully, and no new neurological dysfunction was found within 30 days of follow-up. Through the retrospective analysis of the case and literature review, this paper provides clinical reference.
[1] Mauro D，Thomas R，Guggino G，et al. Ankylosing spondylitis：an autoimmune or autoinflammatory disease? [J]. Nat Rev Rheumatol，2021，17（7）：387-404.
[2] Kim JH，Choi IA. Cardiovascular morbidity and mortality in patients with spondyloarthritis：a meta-analysis [J]. Int J Rheum Dis，2021，24（4）：477-486.
[3] Vlisides PE，Moore LE. Stroke in surgical patients [J]. Anesthesiology，2021，134（3）：480-492.
[4] 张晴晴，温世荣，潘玉君.围手术期急性脑梗死的炎症反应及相关危险因素[J].中风与神经疾病杂志，2022，39（2）：190-192.
[5] Smilowitz NR，Gupta N，Ramakrishna H，et al. Perioperative major adverse cardiovascular and cerebrovascular events associated with noncardiac surgery [J]. JAMA Cardiol，2017，2（2）：181-187.
[6] Meng L，Li J，Flexman AM，et al. Perceptions of perioperative stroke among chinese anesthesiologists：starting a long march to eliminate this underappreciated complication [J]. Anesth Analg，2019，128（1）：191-196.
[7] Tr?觟mmer K，Kostev K，Jacob L，et al. Increased incidence of stroke and transient ischemic attack in patients with rheumatoid arthritis and ankylosing spondylitis in Germany [J]. Neuroepidemiology，2021，55（2）：162-170.
[8] Liu W，Ma W，Liu H，et al. Stroke risk in arthritis：a systematic review and meta-analysis of cohort studies [J]. PLoS One，2021，16（3）：e0248564.
[9] Lee DH，Choi YJ，Han IB，et al. Association of ischemic stroke with ankylosing spondylitis：a nationwide longitudinal cohort study [J]. Acta Neurochir （Wien），2018，160（5）：949- 955.
[10] Kelly PJ，Lemmens R，Tsivgoulis G. Inflammation and stroke risk：a new target for prevention [J]. Stroke，2021，52（8）：2697-2706.
[11] Duffett L. Deep venous thrombosis [J]. Ann Intern Med，2022， 175（9）：ITC129-ITC144.
[12] Dhahri R，Mejri I，Ghram A，et al. Assessment tools for pulmonary involvement in patients with ankylosing spondylitis：is diaphragmatic ultrasonography correlated to spirometry? [J]. J Multidiscip Healthc，2023，16：51-61.
[13] Wolff G，Navarese EP，Brockmeyer M，et al. Perioperative aspirin therapy in non-cardiac surgery：a systematic review and meta-analysis of randomized controlled trials [J]. Int J Cardiol，2018，258：59-67.
[14] Douketis JD，Spyropoulos AC，Murad MH，et al. Perioperative management of antithrombotic therapy：an American College of Chest Physicians clinical practice guideline [J]. Chest，2022，162（5）：e207-e243.
[15] van der Pol S，Jacobs MS，Meijer K，et al. Perioperative bridging of vitamin K antagonist treatment in patients with atrial fibrillation：only a very small group of patients benefits [J]. Europace，2019，21（5）：716-723.
[16] Vlisides PE，Moore LE，Whalin MK，et al. Perioperative care of patients at high risk for stroke during or after non-cardiac，non-neurological surgery：2020 guidelines from the Society for Neuroscience in Anesthesiology and Critical Care [J]. J Neurosurg Anesthesiol，2020，32（3）：210-226.
[17] Lakhotia R，Longani S，Gupta R. Ankylosing spondylitis：what all should anaesthesiologist know? [J]. Indian J Clin Anaesth，2022，9（3）：374-378
[18] 米卫东，王国林，马玉龙，等.中国老年患者围术期缺血性脑卒中防治专家共识[J].临床麻醉学杂志，2022，38（11）：1200-1209.
[19] 李立纲，韩磊，张瑞博，等.强直性脊柱炎合并极重度脊柱后凸畸形矫治术麻醉处理一例[J].临床麻醉学杂志，2022，38（7）：776-778.
[20] Benesch C，Glance LG，Derdeyn CP，et al. Perioperative neu- rological 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 [J]. Circulation，2021，143（19）：e923-e946.
[21] Hu Y，Lim A. MAP 65-is it enough? [J]. Curr Opin Anaesthesiol，2022，35（2）：242-247.
[22] Mazzeffi M，Chow JH，Anders M，et al. Intraoperative hypotension and perioperative acute ischemic stroke in patients having major elective non-cardiovascular non-neurological surgery [J]. J Anesth，2021，35（2）：246-253.
[23] Jessen MK，Vallentin MF，Holmberg MJ，et al. Goal-directed haemodynamic therapy during general anaesthesia for noncardiac surgery：a systematic review and meta-analysis [J]. Br J Anaesth，2022，128（3）：416-433.
[24] Song Q，Li J，Jiang Z. Provisional decision-making for perioperative blood pressure management：a narrative review [J]. Oxid Med Cell Longev，2022，2022：5916040.
[25] 中华医学会麻醉学分会“围术期肺保护性通气策略临床应用专家共识”工作小组.围术期肺保护性通气策略临床应用专家共识[J].中华麻醉学杂志，2020，40（5）：513- 519.
[26] Apfelbaum JL，Hagberg CA，Connis RT，et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway [J]. Anesthesiology，2022， 136（1）：31-81.
[27] 孙德峰.加速术后康复理念下术后镇痛管理策略[J].实用医学杂志，2022，38（17）：2123-2127.
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