Carotid and Intracranial Surgery
Carotid surgeries that are performed to prevent strokes are carotid endarterectomy (CEA), carotid angioplasty/stenting, and transcarotid artery revascularization. CEA is the most frequently performed surgical procedure to prevent stroke in the United States. We discuss preoperative risk assessment and anesthetic management of patients undergoing carotid surgery. Anesthesia for intracranial surgery requires detailed discussion between the anesthesiologist and surgeons regarding patient positioning, intraoperative use of steroids, diuretics, and anticonvulsants, anticipated blood loss, appropriate intraoperative management of blood pressure, PaCO2 and temperature. Anesthetic management of patients undergoing intracranial surgery including cerebral aneurysm surgery and awake craniotomy is also discussed. The management of intracranial pressure (ICP) is a necessary skill for the anesthesiologist. Perioperative ICP management is frequently needed when there is cranial trauma. In this setting, ICP control may have to be attempted empirically on the basis of the clinical neurologic examination, without an actual ICP measurement. Alternatively, therapy may be titrated to a specific ICP if the patient has an intracranial monitor in place.
