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Perioperative stroke is associated with significant morbidity and mortality yet patients may not be aware of their risk or receive appropriate counselling. Our objectives were to 1) compare patient’s perceived vs calculated risk of stroke; 2) determine level of worry; and 3) assess prior discussion about perioperative stroke risk amongst elective patients undergoing non-cardiac, non-neurologic surgery. Over a consecutive four-week period, surveys were distributed at two pre-anesthetic clinics to adult patients scheduled for non-cardiac, non-neurologic surgery. The survey included questions about demographics, perioperative stroke risk factors, patient perception of their quantitative and qualitative stroke risk, level of worry about stroke, and risk discussions. We identified independent predictors of risk underestimation amongst medium- and high-risk patients. Six hundred patients completed the survey (response rate 78%). Of these, 479, 104, and 15 patients were classified as low-, medium-, and high-risk, respectively (with two patients missing this data point). Most medium- (86%) and high-risk (80%) patients did not identify their elevated risk. Amongst medium- and high-risk patients, independent predictors of risk underestimation were lower education and absence of kidney disease. Medium- and high-risk patients were more worried than low-risk patients about perioperative stroke (median [interquartile range] visual analogue scale score 2 [0.5–4] vs 1 [0–2], P = 0.001). Fewer than half of patients had discussed perioperative stroke previously (40%, 23%, and 12% of high-, medium-, and low-risk patients, respectively). Patients at higher risk of stroke frequently underestimate their risk of perioperative stroke. The majority of patients had not discussed perioperative stroke prior to anesthetic consultation.

The purpose of this Continuing Professional Development module is to provide information needed to prepare for and clinically manage a patient in the prone position. Prone positioning is required for surgical procedures that involve the posterior aspect of a patient. We searched MEDLINE® and EMBASE™ from January 2000 to January 2015 for literature related to the prone position and retrieved only original articles in English. We reviewed the advantages and disadvantages of various equipment used in prone positioning, the physiological changes associated with prone positioning, and the complications that can occur. We also reviewed strategies for the safe conduct and management of position-related complications. Increased age, elevated body mass index, the presence of comorbidities, and long duration of surgery appear to be the most important risk factors for complications associated with prone positioning. We recommend a structured team approach and careful selection of equipment tailored to the patient and surgery. The systematic use of checklists is recommended to guide operating room teams and to reduce prone position-related complications. Anesthesiologists should be prepared to manage major intraoperative emergencies (e.g., accidental extubation) and anticipate postoperative complications (e.g., airway edema and visual loss).