Acute Stroke Management in the First 24 Hours

December 2018 • Volume 127 • Number 6 www.anesthesia-analgesia.org e103 DOI: 10.1213/ANE.0000000000003833 Stroke remains among the leading causes of death and disability. Dramatic advances in treatment were made during the past few decades with the evolution of thrombolytic therapy and endovascular interventions. Anesthesiologists frequently care for patients with acute stroke during neurosurgical or endovascular treatment, in the emergency department (ED), or in the intensive care unit. A thorough understanding of current treatment principles is paramount for providing adequate care in these critical cases. Acute Stroke Management in the First 24 Hours is a comprehensive manual targeted at those providing acute care for stroke patients. The editors are among the world’s leading experts in the field. Maxim Mokin, an expert on endovascular therapy, is an assistant professor of neurology and neurosurgery at the University of South Florida. Edward C. Jauch, professor and chair of the department of emergency medicine and neurology at the University of South Carolina, served as chair of the Stroke Council for the American Heart Association (AHA), and coauthored the 2013 as well as the current (2018) AHA guidelines for the treatment of ischemic stroke. Italo Linfante is medical director of interventional neuroradiology in Miami, FL, and president-elect of the Society of Vascular and Interventional Radiology. Adnan Siddiqui is a professor of neurosurgery and radiology at the State University of New York. Elad Levy is also a professor of neurosurgery and radiology at the State University of New York, and serves as medical director of neuroendovascular services at Gates Vascular Institute. The 15 chapters of the book were authored by accomplished experts in their respective areas. The first 2 chapters cover clinical syndromes and definitions and discuss systems of care. The other chapters encompass the acute treatment of ischemic and hemorrhagic stroke covering prehospital treatment, evaluation in the ED, imaging, intravenous, endovascular and surgical treatment, and management of patients after these procedures. One chapter is dedicated to the evolving field of telemedicine. Thus, the book nicely follows the initial clinical path of a stroke patient. Covering only the first 24 hours of treatment, important topics like nutrition, rehabilitation, or prevention of recurrent strokes are not addressed. Each chapter begins with a brief introduction, covers current evidence and controversies, and is concluded with educative clinical cases and summarizing practical points. The e-book is identical to the print version. Other than references, figures, and tables being accessible via hyperlink, there are no additional materials provided in the electronic version. While many textbooks are available covering the treatment of stroke, the editors of this book manage to cover the initial treatment from the prehospital setting to intervention and acute in-hospital care in an easily accessible yet not overly simplified fashion. Given the multitude of authors, the writing style is remarkably consistent, and the outline of the chapters is maintained nicely throughout the book. Each chapter covers the respective topic in a concise and comprehensive manner. The editors have managed to avoid redundancies. The quality of the images provided is sometimes limited, especially when radiological studies are being reproduced. Given the nature of the book, this is understandable and does not limit its educational value. The main issue with the book is its poor timing: the AHA American Stroke Association updated the guidelines for the early management of patients with ischemic stroke in 2018.1 This novel guideline is not reflected in the book. Because several substantial changes were made compared to the 2015/2013 guidelines, the book does not accurately reflect current recommendations in some points. The novel strong recommendation to perform mechanical thrombectomy in selected patients is an important example. Several other recommendations for the medical treatment were revised, with these novel guidelines not reflected in the book. Despite the lack of incorporation of the latest guidelines, the book is still a valuable resource for providers of prehospital treatment, those caring for stroke patients in the ED, anesthesiologists providing care during interventions or surgical procedures, and those providing acute medical care to stroke patients. It is useful as a reference as well as an introductory text for those not having cared for stroke patients or as an update regarding current treatment regimens (despite the lack of incorporation of the latest guidelines) for experienced clinicians. Acute Stroke Management in the First 24 Hours can be recommended for anyone looking for a comprehensive summary of the acute management of stroke. However, readers should be aware of the recently revised guidelines and perhaps have a copy available along with the book.