Carotid endarterectomy
Author - Dr Mark Stoneham
Date published - 21 September 2011
Preoperative assessment of patients undergoing CEA
- Contralateral stenosis
- Blood pressure control
- Presentation of neurological deficit
- Indications for surgery over medical therapy
Knowledge of surgical techniques for carotid surgery and implications for anaesthesia
- Standard endarterectomy
- Eversion tecnique
- Patch angioplasty
- Carotid shunting
Complications of surgery:
- Stroke
- Myocardial infarction
- Nerve injury
- Postoperative wound haematoma management
Comparison of regional and general anaesthetic techniques
- GALA trial
- Benefits of general anaesthesia
- Benefits of regional anaesthesia
- Stroke / MI / mortality rates for GA and LA techniques
Local anaesthetic techniques: methods, complications, limitations
- Cervical plexus block techniques: deep, superficial, intermediate, combined
- Cervical epidural analgesia
General anaesthetic techniques:
- Choice of techniques: inhalational vs TIVA
- Avoidance of nitrous oxide
- Airway management
- Augmentation of blood pressure
Cerebral protection
- Management of cerebral ischaemia during cross-clamping
Techniques for cerebral monitoring during carotid cross-clamping
- Awake patient
- Carotid stump pressure monitoring
- Transcranial Doppler
- EEG
- SSEP
- Near infrared spectroscopy / cerebral oximetry
Peri-operative blood pressure control
- Normal limits
- Intraoperative control
- Vasoactive drug selection
- Postoperative BP control
Postoperative management
- Location: PACU / HDU / ICU
- Cerebral hyperperfusion syndrome
- Airway compromise
- Pain control
- Management of new neurological deficit
Carotid stenting
