Carotid Endarterectomy

 

 

Considerations 

 

  • Shared airway

  • Significant hemodynamic fluctuations:

    • X-clamp: hypertension, tachycardia, increased myocardial O2 demands

    • Carotid sinus manipulation: bradycardia, hypotension

  • Coexisting disease (CAD, DM, HTN, PVD, CKD, CVD, smoking, advanced age)

  • Neuromonitoring (usually EEG, cerebral oximetry, TCD, stump pressure) 

  • Complications:

    • CNS: CVA (ischemic/embolic), hyperperfusion syndrome, CN dysfunction

    • Cardiovascular: MI, labile BP (hypertension/hypotension)

    • Airway: hematoma, airway obstruction/loss, RLN injury

  • Perioperative medication management (ASA, plavix, antihypertensives, statins)

 

 

Anesthetic Goals

 

  • Maintain stable hemodynamics 

  • Optimize cerebral perfusion & protect myocardium 

  • Crisp emergence with awake patient ready for neurological exam 

  • Smooth emergence to minimize risk of bleeding

 

 

Anesthetic Options 

 

  • GA vs. regional (superficial cervical plexus block) vs. local 

  • Carotid artery stenting also an option if patient unsuitable for an anesthetic