Anesthetic Management of Carotid Endarterectomy

Abstract

  There are serious cerebral ischemic complications in carotid endarterectomy (CEA) due to internal carotid artery cross clamping and embolism. It is important for anesthetic management of CEA to understand the state of CEA patients before surgery. We evaluated preoperative risk factors and anesthetic management of CEA using intraoperative monitoring. As a preoperative anesthetic risk, the incidence of circulatory organ disease was common, and there was a significant incidence of ischemic heart disease in the patients with bilateral stenosis of internal carotid artery. Regional cerebral vasoreactivity (rCVR) were measured by single-photon emission CT with acetazolamide challenge preoperatively. Preoperative measurement of rCVR and intraoperative measurement of internal carotid artery flow could identify patients at risk for hyperperfusion syndrome after CEA, and in these selected cases, immediate and adequate postoperative circulatory management were needed. To prevent the intraoperative cerebral ischemia, we measured stump pressure, regional cerebral blood flow by near-infrared spectroscopy, transcranial Doppler and jugular bulb oxygen saturation, and we also recorded somatosensory evoked potential. Intraoperative monitoring was beneficial in terms of reducing operative complications, but sensitivity or efficacy was different in each monitoring. For prevention of cerebral ischemic injury, a multi-modality monitoring system is needed.