ABSTRACT
Carotid endarterectomy is the preferred treatment for a patient with transient ischemic attacks (TIAs) in whom carotid artery stenosis is present. This patient was a 58-year-old male associated with 60 kg in body weight and 172 cm in height. He was scheduled for elective carotid endarterectomy in ASA physical status III. For premedication, he was administered triflupromazine (Veprin ) 10 mg and glycopyrrolate 0.2 mg IM 1 hour prior to induction. Induction was established with thiopental sodium, succinylcholine after preoxygenation. N2O/O2 (2:1), isoflurane and pancuronium were administered for maintenance. For monitoring, ECG, EEG, direct arterial pressure, ETCO2, CVP and rectal temperature were performed. A primary goal of the intraoperative management is the prevention of the cerebral ischemia. He was challenged to maintain adequate cerebral perfusion without causing myocardial ischemia. The EEG is the reliable indication of cortical function during general anesthesia. No signs of the cerebral ischemia were occurred at the time of the carotid occlusion. Minute ventilation was kept mild hypo-or normocapnia. He had no new neurologic deficits and myocardial ischemia, and discharged on 14 day postoperation.
Subject(s)
Humans , Male , Middle Aged , Anesthesia, General , Arterial Pressure , Body Weight , Brain Ischemia , Carotid Stenosis , Electrocardiography , Electroencephalography , Endarterectomy, Carotid , Glycopyrrolate , Ischemic Attack, Transient , Isoflurane , Myocardial Ischemia , Neurologic Manifestations , Pancuronium , Perfusion , Premedication , Succinylcholine , Thiopental , Triflupromazine , VentilationABSTRACT
Carotid endarterectomy is the preferred treatment for a patient with transient ischemic attacks (TIAs) in whom carotid artery stenosis is present. This patient was a 58-year-old male associated with 60 kg in body weight and 172 cm in height. He was scheduled for elective carotid endarterectomy in ASA physical status III. For premedication, he was administered triflupromazine (Veprin ) 10 mg and glycopyrrolate 0.2 mg IM 1 hour prior to induction. Induction was established with thiopental sodium, succinylcholine after preoxygenation. N2O/O2 (2:1), isoflurane and pancuronium were administered for maintenance. For monitoring, ECG, EEG, direct arterial pressure, ETCO2, CVP and rectal temperature were performed. A primary goal of the intraoperative management is the prevention of the cerebral ischemia. He was challenged to maintain adequate cerebral perfusion without causing myocardial ischemia. The EEG is the reliable indication of cortical function during general anesthesia. No signs of the cerebral ischemia were occurred at the time of the carotid occlusion. Minute ventilation was kept mild hypo-or normocapnia. He had no new neurologic deficits and myocardial ischemia, and discharged on 14 day postoperation.
Subject(s)
Humans , Male , Middle Aged , Anesthesia, General , Arterial Pressure , Body Weight , Brain Ischemia , Carotid Stenosis , Electrocardiography , Electroencephalography , Endarterectomy, Carotid , Glycopyrrolate , Ischemic Attack, Transient , Isoflurane , Myocardial Ischemia , Neurologic Manifestations , Pancuronium , Perfusion , Premedication , Succinylcholine , Thiopental , Triflupromazine , VentilationABSTRACT
BACKGROUND: Carotid endarterectomy has been proven to be beneficial for the prevention of strokes in both symptomatic and asymptomatic patients with significant carotid stenosis. Even if there is no consensus as to the most appropriate monitoring method for detecting cerebral ischemia during carotid endarterectomy, electroencephalography (EEG) and/or somatosensory evoked potential (SSEP) has been extensively used to evaluate cerebral functions. We estimated the efficacy of EEG and SSEP for detecting cerebral ischemia during carotid endarterectomy in conscious patients. METHODS: One or both of 16-channel EEG and SSEP monitoring were performed in 103 patients scheduled for carotid endarterectomy under cervical plexus block. We estimated the sensitivity and specificity of EEG and SSEP for detecting cerebral ischemia expressed by altered consciousness and shunt insertion. RESULTS: During carotid clamp in 74 cases studied, significant EEG changes were noted in 5 of the 16 patients who had cerebral ischemia, however 11 patients had no EEG changes despite cerebral ischemia. During carotid clamp in 84 cases studied, significant SSEP changes were noted in 7 of the 19 patients who had cerebral ischemia, however 12 patients had no SSEP changes despite cerebral ischemia. The sensitivity and specificity for detecting cerebral ischemia were 31% and 86% for EEG and 37% and 95% for SSEP, respectively. CONCLUSIONS: We conclude that EEG and SSEP monitoring during carotid endarterectmy under regional anesthesia is not a sensitive method for detecting cerebral ischemia.
Subject(s)
Humans , Anesthesia, Conduction , Brain Ischemia , Carotid Stenosis , Cervical Plexus , Consciousness , Consensus , Electroencephalography , Endarterectomy, Carotid , Evoked Potentials, Somatosensory , Sensitivity and Specificity , StrokeABSTRACT
BACKGROUND: The purpose of this study was to determine the possibility and safety of performing carotid endarterectomy under cervical plexus block. METHODS: Carotid endarterectomy was performed in 30 cases with deep and superficial cervical plexus block, to monitor the patient for cerebral ischemia in the awake state. The toy horn was placed in the contralateral hand in each case and was activated by the patient on command and patients had counted ten repeatedly during carotid clamping. Patients who had not been experienced in the change of mental status or motor response had been operated without a shunt. RESULTS: Cerebral ischemia requiring shunt was observed in one case (3.3%). There were no permanent neurologic deficit and major cardiovascular complication and mortality. CONCLUSIONS: Carotid endarterectomy under cervical plexus block allows direct and precise observation of the patient's central nervous system function during the operation.
Subject(s)
Animals , Humans , Brain Ischemia , Central Nervous System , Cervical Plexus , Constriction , Endarterectomy, Carotid , Hand , Horns , Mortality , Neurologic Manifestations , Play and PlaythingsABSTRACT
We have experienced an anesthetic management of 56-year-old male patient with carotid stenosis. Carotid endarterectomy was performed with processed electroencephalography (compressed spectral array, CSA) monitoring. Carotid endarterectomy has significant risk of perioperative stroke and myocardial infarction. For brain protection during carotid cross clamp, body temperature of patient was maintained at 33.5oC and thiopental was infused continuously to induce burst suppression. To maintain blood pressure during cross clamp, dopamine was infused continuously and phenylephrine was injected intermittently. CSA was performed to monitor thiopental-induced burst suppression and ischemic brain insult. After releasing carotid cross clamp, body temperature was raised to 35oC.