Expert: Dr Ian Jackson - please note UK based - 2/22/2008

Question
Hi, my husband suffered a stroke after a knee replacement, the only explanation that has been offered is that it was a complication of the anaesthetic (epidural).  
Could you please advise whether there is any risk of stroke with a dental anaesthetic, as he is terrified he will have another stroke.
Thank you

Answer
Hi there Kathryn
I am sorry to hear about your husbands problem. This is a complex issue and I do not have all the info I need to say anything categorically.
However I wonder who said to you that his stroke was caused by the anaesthetic? Was this the anaesthetist or the surgeon or some other individual. I find it hard to believe that his anaesthetic caused his stroke, but it might have played a part.
There are 2 broad types of stroke - one where the blood supply to the area of brain affected is cut off due to low pressure in the supply or more often due to a little 'plug' of material blocking the vessel, the other type is where the vessel actually bleeds into the brain tissue causing damage directly to the tissues.
So it is possible that your husband had a period of low blood pressure during his operation (which can be linked to the anaesthetic) which led to a problem with blood supply to a small part of his brain, or a little plug could have caused it (perhaps linked to the actual operation or due to a faulty heart rhythm called atrial fibrillation which can lead to problems with stroke). Finally he could have had an episode of very high blood pressure during the operation that made a weakness in a vessel in his brain bleed. The last option would seem unlikely so that leaves us with the previous 2.
I wonder if he has had any investigations since his stroke to check that the main vessels in his neck (the carotids) do not have any problems with 'furring up'. I assume he has as this would be appropriate.
So given all the complex stuff above I think that it is unlikely that he would experience further problems if he is managed appropriately and explains the problem he has experienced this time. However I find it unsatisfactory that he and you have been left worrying about this issue and I would request the opportunity to discuss this further with a doctor who can explain what happened and what the risks are for future problems. I beleive he should be investigated to ensure he has no issues as I have described above contributing to this problem and be told if he needs to take long term medication e.g. aspirin.
I hope this long story helps a bit.
Kind regards
Dr Ian Jackson