Anaesthetic methods for carotid surgery

Abstract

The pathophysiology and consequences of occlusive atherosclerotic disease of carotid arteries are discussed. Careful preoperative assessment of a patient scheduled for carotid surgery is needed owing to coexisting medical problems. The premedication with a benzodiazepine is recommended. A variety of anaesthetic technique are used to anaesthetize patients undergoing carotid endarterectomy. There is no evidence that one particular technique is superior to another. All intravenous induction agents, except ketamin, reduce CMRO, and may be cerebroprotective, but their effects on rCBF are very different. Isoflurane in a concentration of less than 1 MAC supplemented with opioids or total intravenous anaesthesia with propofol, or midazolam in combination with synthetic opioids have proved to be acceptable methods for carotid endarterectomy. Loco-regional anaesthesia (cervical plexus or epidural block) gives a chance for continuous neurological assessment. Intraoperative monitoring should include the routine monitors of cardiovascular, respiratory and metabolic function employed during general or loco-regional anaesthetics. Additional monitoring techniques (EEG, SSEP, rCBF internal carotid stump pressure, JSO 2 or cerebral oximetry) may be valuable. In the postoperative period the high-risk patient should, ideally, be transferred to a high-dependency unit and can be observed for postoperative complication.