Sukegawa et al identified risk factors for perioperative stroke in a patient with head and neck cancer. A patient identified as being at increased risk for stroke may benefit from more aggressive management. The authors are from Kagawa Prefectural Central Hospital and Shimane University in Japan.
Patient selection: head and neck cancer
General risk factors for perioperative stroke in a patient with head and neck cancer:
(1) older age
(2) atherosclerosis of the carotid arteries
(3) history of stroke
(4) emboli from the heart (atrial fibrillation, valvular disease)
(5) beta-blockers
(6) renal dysfunction
Specific risk factors during surgery for a head and neck dissection:
(1) neck dissection
(2) rotation and hyperextension of the neck
(3) preoperative radiation therapy to the head and neck
Management recommendations:
(1) The patient should be receiving statins (with the goal to stabilize atherosclerotic plaque).
(2) Surgery should be done quickly and carefully.
(3) Maintain adequate sedation postoperatively, preferrably using an agent which allows the patient to be easily roused.
(4) Monitor for neurologic evidence of a stroke.
