{"title":"Anaesthesia for carotid surgery","authors":"Ryan Barter, Helen Alexander","doi":"10.1016/j.mpaic.2024.11.006","DOIUrl":null,"url":null,"abstract":"<div><div>Stroke is a leading cause of morbidity and mortality and may be preceded by a transient ischaemic attack (TIA). 20% will have a carotid stenosis caused by atheromatous plaque which can be removed by carotid endarterectomy, reducing the risk of further stroke.</div><div>Risk of stroke is highest in the immediate period following TIA and surgery is recommended within 7 days. The benefits of surgery are highest in those with more than 70% stenosis. Preoperative optimization is limited by the urgency of surgery, but assessment focuses on associated cardiac and respiratory comorbidities including blood pressure control.</div><div>Carotid endarterectomy can be performed under general or regional anaesthesia (with superficial or intermediate cervical plexus blocks) and while large trials have shown no significant difference in outcomes, there are advantages and disadvantages to each. Intraoperative blood pressure control and care with the effects of positioning is required. Smooth emergence with early neurological assessment is the aim with general anaesthesia. The main risk of surgery is postoperative stroke but there is no high-quality evidence for intraoperative shunting or cerebral monitoring in reducing this.</div><div>Other postoperative complications include cardiac ischaemia, hypertension including cerebral hyperperfusion syndrome and airway compromise due to oedema/haematoma.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 2","pages":"Pages 108-111"},"PeriodicalIF":0.3000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Anaesthesia and Intensive Care Medicine","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1472029924002455","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/12/15 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Stroke is a leading cause of morbidity and mortality and may be preceded by a transient ischaemic attack (TIA). 20% will have a carotid stenosis caused by atheromatous plaque which can be removed by carotid endarterectomy, reducing the risk of further stroke.
Risk of stroke is highest in the immediate period following TIA and surgery is recommended within 7 days. The benefits of surgery are highest in those with more than 70% stenosis. Preoperative optimization is limited by the urgency of surgery, but assessment focuses on associated cardiac and respiratory comorbidities including blood pressure control.
Carotid endarterectomy can be performed under general or regional anaesthesia (with superficial or intermediate cervical plexus blocks) and while large trials have shown no significant difference in outcomes, there are advantages and disadvantages to each. Intraoperative blood pressure control and care with the effects of positioning is required. Smooth emergence with early neurological assessment is the aim with general anaesthesia. The main risk of surgery is postoperative stroke but there is no high-quality evidence for intraoperative shunting or cerebral monitoring in reducing this.
Other postoperative complications include cardiac ischaemia, hypertension including cerebral hyperperfusion syndrome and airway compromise due to oedema/haematoma.
期刊介绍：
Anaesthesia and Intensive Care Medicine, an invaluable source of up-to-date information, with the curriculum of both the Primary and Final FRCA examinations covered over a three-year cycle. Published monthly this ever-updating text book will be an invaluable source for both trainee and experienced anaesthetists. The enthusiastic editorial board, under the guidance of two eminent and experienced series editors, ensures Anaesthesia and Intensive Care Medicine covers all the key topics in a comprehensive and authoritative manner. Articles now include learning objectives and eash issue features MCQs, facilitating self-directed learning and enabling readers at all levels to test their knowledge. Each issue is divided between basic scientific and clinical sections. The basic science articles include anatomy, physiology, pharmacology, physics and clinical measurement, while the clinical sections cover anaesthetic agents and techniques, assessment and perioperative management. Further sections cover audit, trials, statistics, ethical and legal medicine, and the management of acute and chronic pain.
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