ArticleAnesthesiology2022
Carbon Dioxide, Blood Pressure, and Perioperative Stroke: A Retrospective Case-Control Study.
Article in Anesthesiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 27 citations in OpenAlex.
- Explainable multi-modal approach for uncovering key predictors of stroke-risk from ECG, EMG, blood pressure, and respiratory signals.Scientific reports · 2026Article
- Risk factors and the role of intraoperative hypotension in cerebral infarction after microsurgical clipping of intracranial aneurysms: a retrospective case-control study.Neurosurgical review · 2025Article
- The association between intraoperative end-tidal carbon dioxide and prognosis in cardiac surgery patients: a retrospective cohort study.BMC cardiovascular disorders · 2025Article
- Covert Strokes in Patients Having Surgery: Comment.Anesthesiology · 2025Article
- Stroke after surgery for lumbar spinal stenosis: a retrospective register-based study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2025Article
- Risk factors and prognosis of silent cerebral infarction after transcatheter aortic valve replacement.Scientific reports · 2025Article
- A review of machine learning methods for non-invasive blood pressure estimation.Journal of clinical monitoring and computing · 2025Review
- Influencing and prognostic factors of end-stage hypertrophic cardiomyopathy.ESC heart failure · 2024Article
- Perioperative stroke.Nature reviews. Disease primers · 2024Review
- DAANISH: A mnemonic to aid in memorizing and recalling important strategies contributing to the prevention of perioperative stroke.Qatar medical journal · 2024Review
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18 authors at 6 institutions in 2 countries.
Funding
Abstract
backgroundThe relationship between intraoperative physiology and postoperative stroke is incompletely understood. Preliminary data suggest that either hypo- or hypercapnia coupled with reduced cerebrovascular inflow (e.g., due to hypotension) can lead to ischemia. This study tested the hypothesis that the combination of intraoperative hypotension and either hypo- or hypercarbia is associated with postoperative ischemic stroke.
methodsWe conducted a retrospective, case-control study via the Multicenter Perioperative Outcomes Group. Noncardiac, nonintracranial, and nonmajor vascular surgical cases (18 yr or older) were extracted from five major academic centers between January 2004 and December 2015. Ischemic stroke cases were identified via manual chart review and matched to controls (1:4). Time and reduction below key mean arterial blood pressure thresholds (less than 55 mmHg, less than 60 mmHg, less than 65 mmHg) and outside of specific end-tidal carbon dioxide thresholds (30 mmHg or less, 35 mmHg or less, 45 mmHg or greater) were calculated based on total area under the curve. The association between stroke and total area under the curve values was then tested while adjusting for relevant confounders.
resultsIn total, 1,244,881 cases were analyzed. Among the cases that screened positive for stroke (n = 1,702), 126 were confirmed and successfully matched with 500 corresponding controls. Total area under the curve was significantly associated with stroke for all thresholds tested, with the strongest combination observed with mean arterial pressure less than 55 mmHg (adjusted odds ratio per 10 mmHg-min, 1.17 [95% CI, 1.10 to 1.23], P < 0.0001) and end-tidal carbon dioxide 45 mmHg or greater (adjusted odds ratio per 10 mmHg-min, 1.11 [95% CI, 1.10 to 1.11], P < 0.0001). There was no interaction effect observed between blood pressure and carbon dioxide.
conclusionsIntraoperative hypotension and carbon dioxide dysregulation may each independently increase postoperative stroke risk. EDITOR’S PERSPECTIVE:
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.