Dana RaubKatharina PlatzbeckerStephanie D. GrabitzXinling XuKaruna WongtangmanStephanie B. PhamKadhiresan R. MurugappanKhalid A. HanafyAla NozariTimothy T. HouleSamir M. KendaleMatthias EikermannSiriraj HospitalUniversitätsklinikum EssenBoston Medical CenterHarvard Medical School2022-08-042022-08-042021-01-01Journal of the American Heart Association. Vol.10, No.5 (2021), 1-44204799802-s2.0-85102536541https://repository.li.mahidol.ac.th/handle/20.500.14594/78797BACKGROUND: Preclinical studies suggest that volatile anesthetics decrease infarct volume and improve the outcome of is-chemic stroke. This study aims to determine their effect during noncardiac surgery on postoperative ischemic stroke incidence. METHODS AND RESULTS: This was a retrospective cohort study of surgical patients undergoing general anesthesia at 2 tertiary care centers in Boston, MA, between October 2005 and September 2017. Exclusion criteria comprised brain death, age <18 years, cardiac surgery, and missing covariate data. The exposure was defined as median age-adjusted minimum alveolar concentration of all intraoperative measurements of desflurane, sevoflurane, and isoflurane. The primary outcome was postoperative ischemic stroke within 30 days. Among 314 932 patients, 1957 (0.6%) experienced the primary outcome. Higher doses of volatile anesthetics had a protective effect on postoperative ischemic stroke incidence (adjusted odds ratio per 1 minimum alveolar concentration increase 0.49, 95% CI, 0.40–0.59, P<0.001). In Cox proportional hazards regression, the effect was observed for 17 postoperative days (postoperative day 1: hazard ratio (HR), 0.56; 95% CI, 0.48–0.65; versus day 17: HR, 0.85; 95% CI, 0.74–0.99). Volatile anesthetics were also associated with lower stroke severity: Every 1-unit increase in minimum alveolar concentration was associated with a 0.006-unit decrease in the National Institutes of Health Stroke Scale (95% CI, −0.01 to −0.002, P=0.002). The effects were robust throughout various sensitivity analyses including adjustment for anesthesia providers as random effect. CONCLUSIONS: Among patients undergoing noncardiac surgery, volatile anesthetics showed a dose-dependent protective effect on the incidence and severity of early postoperative ischemic stroke.Mahidol UniversityMedicineArticleSCOPUS10.1161/JAHA.120.018952