Carotid endarterectomy

Author - Dr Mark Stoneham

Date published - 21 September 2011

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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


 

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