Perioperative considerations for carotid endarterectomy

Affiliations

Advocate Illinois Masonic Medical Center

Abstract

Carotid endarterectomy (CEA) is a common surgical technique for carotid revascularization. CEA is done in order to prevent cerebral vascular accidents (CVAs) or strokes. There is a high risk of morbidity and mortality, such as myocardial infarction and CVA, associated with this procedure. Therefore, different types of anesthetic management and various neuromonitoring techniques have been recommended by investigators. General anesthesia with inhaled anesthetics has demonstrated better neuroprotection from focal cerebral ischemia when compared with regional anesthesia. Regional anesthesia has been associated with less hemodynamic fluctuation and decreased risk of perioperative myocardial ischemia. Superficial, intermediate, and deep cervical plexus blocks (or a combination of superficial and deep cervical plexus blocks) are recognized regional anesthetic techniques utilized for CEA. In addition, neuromonitoring techniques such as somatosensory evoked potentials, motor-evoked potentials, cerebral oximetry, and patient response during regional anesthesia have been utilized to minimize cerebral ischemia intraoperatively. This chapter summarizes the perioperative considerations for patients undergoing CEA.

Type

Book Chapter

Book Chapter/Book Details

In: Urman R, Kaye A, eds. Vascular Anesthesia Procedures. Oxford University Press; 2020.


 

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