ABSTRACT

Carotid endarterectomy is a prophylactic operation and may be carried out under loco-regional or general anesthesia. In the current practice of carotid endarterectomy, anesthesiologists and surgeons usually choose the anesthesia technique they are most comfortable with. Local anesthesia has the advantage of direct neurological monitoring of the conscious patient. However, patients and surgeons may find ıt stressful. In contrast, when the patient is under general anesthesia, it may be more difficult to detect cerebral ischemia. A number of techniques and monitors are available to detect cerebral ischemia, but none is totally effective. In addition, patients presenting with carotid endarterectomy suffer from hypertension and are at significant risk of perioperative myocardial ischemia and infarction. Anesthesia should be conducted carefully with a view to hemodynamic stability. Direct arterial pressure, automated ST-segment analysis, and five-lead ECG monitoring should be used. Adequate cerebral perfusion must be maintained to minimize the risk of cerebral ischemia secondary to a reduction in cerebral perfusion after crossclamping. This requires normocapnia, adequate arterial oxygenation, and near-baseline mean arterial pressure. Indeed, the mean arterial pressure level may be 20% above the preoperative level. The anesthetist has an important role in controlling perioperative and postoperative risk in carotid endarterectomy. By careful attention to detail in all phases of the procedure, the anesthetist can make a significant contribution to a successful outcome. The principles of careful neurological and cardiovascular assessment need optimum conditions for cerebral perfusion and cardiovascular perfusion. (JAREM 2014; 2: 41-4)