With an ageing population and increasing incidence of cerebrovascular disease, an increasing number of patients presenting for routine and emergency surgery have a prior history of stroke. This presents a challenge for pre-, intra-, and postoperative management as the neurological risk is considerably higher. Evidence is lacking around anaesthetic practice for patients with vascular neurological vulnerability. Through understanding the pathophysiological changes that occur after stroke, insight into the susceptibilities of the cerebral vasculature to intrinsic and extrinsic factors can be developed. Increasing understanding of post-stroke systemic and cerebral haemodynamics has provided improved outcomes from stroke and more robust secondary prevention, although this knowledge has yet to be applied to our delivery of anaesthesia in those with prior stroke. This review describes the key pathophysiological and clinical considerations that inform clinicians providing perioperative care for patients with a prior diagnosis of stroke.

中文翻译：

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先前有缺血性中风的患者围手术期的病理生理和临床考虑：多学科叙述性综述。

随着人口老龄化和脑血管疾病的发生率增加，进行常规和急诊手术的患者数量增加，具有中风的病史。由于神经系统的风险要高得多，因此这对术前，术中和术后管理提出了挑战。血管神经系统脆弱性患者在麻醉实践中缺乏证据。通过了解中风后发生的病理生理变化，可以了解脑血管对内在和外在因素的敏感性。对卒中后全身和脑部血流动力学的了解不断加深，卒中后的结局得到了改善，二级预防更加有效，尽管这些知识尚未应用到我们先前有过中风的人中进行麻醉的过程中。这篇综述描述了关键的病理生理和临床注意事项，这些注意事项可告知临床医生为先前诊断为中风的患者提供围手术期护理。