1992 Volume 85 Issue 2 Pages 267-272
A 66-year-old man with bilateral internal carotid artery occlusion had a cerebral infarction after an endonasal operation under local anesthesia with so-called cocktail premedication. Because his preoperative physical examination was normal, routine cocktail premedication was given. The operation was performed without any trouble, but after operation, his blood pressure and level of consciousness were reduced and his tongue was deflected posteriorly. CT scan after operation showed cerebral infarction and brain atrophy. DSA (digital subtraction angiogram) proved bilateral old internal carotid artery occlusion. 1231-IMP SPECT (single photon emission computed tomography) showed severe decrease of cerebral blood flow.
In our clinic, 27 of 519 patients (5.2%) operated on under local anesthesia with cocktail premedication had various side effects, but all were transient. This patient had bilateral internal carotid artery occlusion before operation and apparent cerebral infarction due to drop of blood pressure- a rare occurrence. It was impossible to predict bilateral internal carotid artery occlusion at the time of preoperative routine physical examination. To find bilateral internal carotid artery occlusion without symptoms is an important problem to be solved.
