Principes de prise en charge de l'ischémie cérébrale : ce que l'anesthésiste-réanimateur doit savoir

The management of stroke is increasingly implicating anesthesiologists because of new invasive procedures (thrombectomy and decompressive craniectomy) and less restrictive criteria for intensive care unit admission. Reperfusion is achieved through the administration of fibrinolytic or endovascular desobstruction. In selected patients endovascular treatment requiring specific anaesthetic support, improves functional outcomes. In case of massive hemispheric ischemia, decompressive craniectomy may reduce the mortality rate to the expense of an increased proportion of severe disabled surviving patients. Patients are managed in intensive care to control secondary brain injury, to treat organ failure, and to prevent and treat complications. Withdrawing life-support therapies during the acute phase should take into consideration the difficulties of evaluating the prognosis and expected quality of live.