Can Haste in Pre-Anaesthetic Check-up Increase the Chances of Post-Operative Stroke: A Case Report Dipti Saxena * , Atul Dixit, Bipin Arya and Sadhana Sanwatsarkar Sri Aurobindo Institute of Medical Sciences and PG Institute, Indore, India * Corresponding author: Dipti Saxena, Sri Aurobindo Institute of Medical Sciences and P.G. Institute, Indore, India, Tel: 91-0731-24231718; E-mail: diptisaxena08@yahoo.co.in Received date: December 22, 2016; Accepted date: January 18, 2017; Published date: January 23, 2017 Copyright: © 2017 Saxena D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Background: In cardiac, neurologic, and carotid surgery, the incidence of stroke is known to be high (2.2-5.2%). Laparoscopy has been considered as low risk for stroke. Here we report a case of stroke in patient who underwent laparoscopic nephrectomy. Previous history of stroke was not disclosed at the time of surgery. Effect on intra- operative management due to this lapse and how it could have been rectified, has been discussed here. Case presentation: This article reports a case of post-operative stroke in a 58 yr old male with moderate obesity that underwent laparoscopic nephrectomy under general anesthesia. Patient did not give any history of previous transient ischemic attack (TIA) although he had an episode of the same a year back. Intraoperatively, anti- hypertensives were used to control high blood pressure. Post extubation it was noted that he was unable to vocalize and move right upper and lower limbs. CT scan revealed fresh watershed infarct in frontoparietal region and an old infarct in occipital region. Conclusion: Importance of history taking especially in elderly patients cannot be undermined. It is important not only for intraoperative management but for risk stratification and medico legal purpose as well. Keywords: Case report; Peri operative stroke; Pre anesthetic checkup; Laparoscopic surgery Introduction Stroke is commonly defned as the sudden onset of focal neurologic or retinal symptoms associated with cerebral or retinal tissue ischemia [1]. Perioperative stroke is defned as a brain infarction of ischemic or hemorrhagic etiology that occurs during surgery or within 30 days afer surgery [2]. Tree of the most consistent risk factors for perioperative stroke identifed in the literature are advanced age, renal failure, and a history of stroke or transient ischemic attack [3-8]. Mashour et al. further identifed myocardial infarction within 6 months of surgery, hypertension, history of severe chronic obstructive pulmonary disease, current tobacco use, and a protective efect of Body Mass Index (BMI) of 35-40 kg/m 2 as independent predictors [9]. Surgical procedures also infuence the incidence of stroke. Although no evaluation as to the risk during laparoscopy has been done, laparoscopic procedures can be considered as low risk for stroke. Tis article reports a case of post- operative transient ischemic attack (TIA) of embolic nature immediately afer surgery in a patient of non- functioning kidney who underwent laparoscopic nephrectomy. Case Report A 58 yr old obese male with a BMI of 38Kg/m 2 , presented with complaints of fever and abdominal pain in the department of urology in our institute. Investigations revealed non-functioning lef kidney and laparoscopic lef nephrectomy was planned. He had no other associated co-morbidity but ECG revealed ST-T changes in lead III and aVf. All other lab investigations were within normal limits. He gave no history of chest pain, dysponea on exertion or hypertension but in view of age and major surgery a cardiology opinion was sought. Fitness was given once Tread Mill Test turned out to be negative and 2D-echo was within normal limits. Pre-operative vitals were: pulse 92/min, BP 160/92 mmHg and SpO 2 98%. Induction was done with inj. Glycopyrrolate (GPL) 0.2 mg and inj. Midazolam 1mg, inj. Fentanyl 100 µg, inj. Propofol 120 mg and inj succinylcholine 100 mg. Ventilation was difcult as anticipated but endotracheal tube was successfully secured in single attempt. SpO 2 was 90% at the time of intubation which came back to 100% once patient was ventilated with endotracheal tube in situ. For maintenance, O 2 , N 2 O and sevofurane was used. However BP remained 180/100 mmHg despite adequate depth of anaesthesia and appropriate analgesia. Hence a bolus of nitro-glycerine (NTG) along with clonidine 75 µg was given. Blood pressure remained in the range of 110-95 mmHg (systolic) and 85-95 mmHg (diastolic) throughout the procedure. Other vitals remained within normal limits and patient was extubated afer reversal with inj. Neostigmine 3.0 mg+inj. GPL 0.4 mg i.v. Post extubation it was noted that he was unable to vocalize and move right upper and lower limbs. Neurology opinion was sought. CT scan revealed fresh watershed infarct in frontoparietal region and an old infarct in occipital region. On interrogation, attendant confrmed a similar episode one year back for which patient had taken some Ayurvedic treatment. He had recovered completely then. Afer 6 h post operatively patient had recovered fully with power 5/5 in both limbs and normal vocalization. He remained alright for an hour so and then deteriorated again. An embolic phenomenon was suspected. 2D-Echo was normal but carotid Doppler revealed acute on chronic thrombus critically reducing (70% blockage) the lumen of lef internal carotid artery while right internal carotid artery was also partially narrowed. Saxena et al., J Anesth Clin Res 2017, 8:1 DOI: 10.4172/2155-6148.1000699 Case Report Open Access J Anesth Clin Res, an open access journal ISSN:2155-6148 Volume 8 • Issue 1 • 1000699 J o u r n a l o f A n e s t h e s i a & C l i n i c a l R e s e a r c h ISSN: 2155-6148 Journal of Anesthesia & Clinical Research