Carotid endarterectomy
Anesthesia type |
GETA vs. regional anesthesia |
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Airway |
Endotracheal Tube |
Lines and access |
PIV x 2 18 ga or larger is adequate |
Monitors |
Standard monitors, arterial line |
Primary anesthetic considerations | |
Preoperative | |
Intraoperative | |
Postoperative | |
Article quality | |
Editor rating | |
User likes | 2 |
Carotid endarterectomy (CEA) is a surgical procedure for treating occlusive atherosclerotic disease involving the common and internal carotid arteries. The procedure is more effective than medical management for patients with high grade stenosis (70–99%), symptomatic moderate stenosis (50-69%), or asymptomatic high-grade stenosis (≥ 60%). CEA involves making a longitudinal incision along the anterior border of the sternocleidomastoid muscle to expose the common, internal, and external carotid arteries as well as the carotid sinus. The carotid artery is then opened and the atherosclerotic plaque is removed. Opening of the carotid artery requires occlusion of the proximal common carotid and distal internal and external carotid arteries, which requires adequate collateral flow from the contralateral common carotid artery or placement of an internal shunt between the proximal common carotid and the distal internal carotid arteries. On removal of the atherosclerotic plaque, the media and adventitia of the arteries may be re-approximated or a graft may be used. These grafts are typically synthetic, but vein grafts are occasionally used.
Preoperative management
Patient evaluation
System | Considerations |
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Neurologic | |
Cardiovascular | |
Respiratory | |
Gastrointestinal | |
Hematologic | |
Renal | |
Endocrine | |
Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Patients are positioned supine with the head turned away from operative site. Beach chair may be used for comfort in awake patients
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
Variant 1 | Variant 2 | |
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Unique considerations | ||
Position | ||
Surgical time | ||
EBL | ||
Postoperative disposition | ||
Pain management | ||
Potential complications |