Anaesthesia for carotid endarterectomy
Carotid arterial atherosclerosis is a common cause of stroke. The internal carotid artery and the carotid bifurcation are the locations most frequently affected by carotid atherosclerosis. Carotid endarterectomy (CEA) is an established revascularization intervention that removes atherosclerotic plaque. In this algorithm, we will review the anaesthetic management of an elderly patient undergoing CEA, utilizing two possible options.
Review
Carotic endarterectomy is one of a few curative (operative) procedures that allows to significantly reduce the risk of an ischemic stroke. During the procedure, it is necessary to temporarily interrupt the blood flow in the impaired carotid artery. If the blood flow trough the collateral circulation of the circle of Willis is insufficient, it could lead to the development of brain ischemia. As a result the question of appropriate anaesthesia and monitoring of the patient during surgery is a subject of long-lasting discussions and disputes. This algorithm presents the essentials in the decision-making process whilst taking care of a patient undergoing CEA in a very simple and educative way including the response to possible complications.
Sources
AUGOUSTIDES, John and Jacob T GUTSCHE, SLINGER, Peter D and Nancy A NUSSMEIER, ed. Anesthesia for carotid endarterectomy and carotid stenting. Uptodate.com [online]. 2019, 6.3.2019 [cit. 2019-03-15]. Available at: https://www.uptodate.com/contents/anesthesia-for-carotid-endarterectomy-and-carotid-stenting?csi=f68d36a8-4d73-47fc-9bbe-6401ea736837&source=contentShare#H1643653009
HEYER, Eric J., Joanna L. MERGECHE, Zirka H. ANASTASIAN, Minjae KIM, Kaitlin A. MALLON and E. Sander CONNOLLY. Arterial Blood Pressure Management During Carotid Endarterectomy and Early Cognitive Dysfunction. Neurosurgery [online]. 2014, 74(3), 245-253 [cit. 2019-03-14]. DOI: 10.1227/NEU.0000000000000256. ISSN 0148-396X. Available at: https://academic.oup.com/neurosurgery/article-lookup/doi/10.1227/NEU.0000000000000256
LI, Jian, Ahmed SHALABI, Fuhai JI and Lingzhong MENG. Monitoring cerebral ischemia during carotid endarterectomy and stenting. Journal of Biomedical Research [online]. 2017, 2017(1), 6 [cit. 2019-03-14]. DOI: 10.7555/JBR.31.20150171. ISSN 16748301. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5274507/
HUGHES, Richard and Richard TELFORD. Anaesthesia for carotid endarterectomy. World federation of societies of anaesthesiologists[online]. 2007, 2.7.2007 [cit. 2019-03-15]. Available at: https://www.wfsahq.org/component/mijosearch/search?query=Anesthesia%20for%20carotid%20endartectomy
