Hypertension is not usually considered acceptable in patients with abnormal coagulation, including von Willebrand's disease. This chapter presents a case study of a 56-year-old male reporting a remote history of stroke with residual left-sided weakness, prior radiation therapy of a pontine brain tumor, ventriculoperitoneal (VP) shunt. Transfusion of platelets became necessary to control excessive and persistent bleeding from the prostate bed. After completion of surgery the patient was permitted to awaken from anesthesia and to be tracheally extubated after exhibiting the ability to sustain head lift and follow commands. It is most important to consider this entire range of possible complications and management options in VP shunt patients undergoing laparoscopic procedures, which require coordination, advanced planning, and continued close cooperation between the surgical and anesthesia teams if potentially serious adverse sequelae are to be averted.

Perioperative acute ischemic stroke (AIS) is a feared complication of surgery that is associated with increased in-hospital mortality, length of hospital stay, disability, and discharge to long-term care facilities. This chapter presents a case study of a 70-year-old female with a past medical history of hypertension, hypercholesterolemia, myocardial infarction, and morbid obesity. Since treatment with intravenous tissue plasminogen activator (tPa) is contraindicated after major surgical procedures, the patient was taken to the interventional radiology suite and endovascular mechanical thrombolysis was performed. The main risk factors for perioperative stroke include (1) female sex, (2) advanced age, (3) atrial fibrillation, (4) cardiac valvular disease, (5) congestive heart failure, (6) history of previous transient ischemic attack (TIA) or stroke, (7) renal disease, (8) diabetes mellitus, (9) hypertension, and (10) general anesthesia. Preoperative evaluation of patients should focus on identifying and correcting potentially modifiable risk factors to reduce the risk of this devastating complication.