Korean J Anesthesiol.  1997 Aug;33(2):254-261. 10.4097/kjae.1997.33.2.254.

Anesthetic Management of Carotid Endarterectomy under EEG and SEP Monitoring

• Lee JJ
• Kang JW
• Yang MK
• Hahm TS
• Kim CS
• Kim GS
• Lee BD

• KMID: 2091125
• DOI: http://doi.org/10.4097/kjae.1997.33.2.254

Abstract

BACKGROUND: Carotid endarterectomy is a very high risk operation, combined with high incidence of stroke and myocardial infarction. We experienced 36 cases of carotid endarterectomies during the last two years. We reviewed these cases with anesthetic management and neurologic monitoring.
METHODS
All of the operations were performed under general anesthesia. 33 cases were monitored by EEG and SEP. We maintained cerebral perfusion during cross-clamping and shunt by normothermia, normocarbia and mild hypertension.
RESULTS
33% of the patients had severe coronary artery stenosis and 41% had severe contralateral carotid artery stenosis preoperatively. During the operation, 10 patients showed transient EEG changes without SEP change or neurologic sequele. The major postoperative complication was myocarial infarction in one patient. There were 3 cases of postoperative cerebral infarction in radiologic findings. One case occurred after myocardial infarction and the other two cases showed no clinical evidence of neurologic deficit.
CONCLUSIONS
In anesthetic management of carotid endarterectomy patients, maintaining cerebral perfusion, preventing perioperative myocardial infarction are important and monitoring neurologic function with EEG and SEP should be considered to prevent neurologic deficits.

Keyword

Anesthesia, carotid endarterectomy; Monitoring, electroence-phalography, evoked potentials

MeSH Terms

Anesthesia, General
Carotid Stenosis
Cerebral Infarction
Coronary Stenosis
Electroencephalography*
Endarterectomy, Carotid*
Humans
Hypertension
Incidence
Infarction
Myocardial Infarction
Neurologic Manifestations
Perfusion
Postoperative Complications
Stroke