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Anesthesiology pp 645-655 | Cite as

Anesthesia for Carotid Endarterectomy

  • Abigail Monnig
  • Gaurav Budhrani
Chapter

Abstract

Prevention of stroke related to carotid stenosis can be surgically managed with carotid endarterectomy (CEA). This chapter focuses on the anesthetic management of patients for CEA. Preoperative considerations include the urgency and timing of the intervention, as well as the need for further workup for coronary atherosclerosis. Both general and regional anesthesia are acceptable techniques. Intraoperative monitoring for neurologic deficits is required, regardless of the anesthetic technique. This can be achieved with EEG, SSEPs, transcranial dopplers, stump pressures or by evaluating the awake patient. During carotid cross clamping, ipsilateral blood flow via collateral circulation can be improved by increasing the patient’s baseline pressure. However, in some patients shunting is required while the cross clamp is applied. Other intraoperative anesthetic implications include monitoring and treatment of hemodynamic lability. Current evidence does not clearly define a “best” anesthetic management plan. Considering the patient’s characteristics, surgeon’s comfort, and access to specific neurologic monitoring devices, can assist in guiding the anesthesiologist in creating an appropriate anesthetic plan.

Keywords

Carotid endarterectomy General versus regional Carotid stenosis Cervical plexus block Anesthetic considerations Surgical management of stroke 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of AnesthesiologyEmory University School of MedicineAtlantaUSA
  2. 2.Division of Critical Care Medicine, Department of AnesthesiologyEmory University School of MedicineAtlantaUSA

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