Aliases:
CEA
Carotid endarterectomy
Awake carotid
Asleep carotid

Topic aliases are alternate phrasings for a particular topic.


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Appropriate time for CEA after a cerebral event is within 2 weeks.
refl.in/3t

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May 18, 2011
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Awake patient may become unsettled on completion of a shunt intraoperatively during the reperfusion stage.
This will usually settle within a few minutes.

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Dec 24, 2012
#TL #Peninsula
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In the presence of postoperative seizures thought due to hyperperfusion syndrome, treatment with anticonvulsants is indicated. refl.in/9g

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Jul 12, 2011
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If awake technique: At the time of clamping the carotid artery ask the patient to continually squeeze your hand to monitor level of consciousness.

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Jun 02, 2011
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Administer any protamine slowly to avoid increased pulmonary hypertension and decreased cardiac output.

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Dec 07, 2012
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Occasionally a surgeon may request a dextran infusion

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May 18, 2011
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Consider topicalising the trachea and vocal chords with local anaesthetic to reduce coughing on extubation.

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If awake technique, be prepared for conversion to general anesthesia

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Consider performing superficial cervical plexus-block only. Risk of complications associated with performing a deep cervical plexus block is probably too high. Allow surgeon to anaesthetise the carotid sheath/body under direct vision.

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GALA 2008 trial showed no difference in rates of stroke, myocardial infarction, or death between GA vs local for CEA refl.in/1c

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May 18, 2011
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Local anaesthetic in an awake patient technique must cover C2-C4 dermatomes + trigeminal + CN to carotid sheath.
Superficial cervical block (by anaesth) plus deep cervical block + trigeminal + sheath (by surgeon) #ref

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Apr 06, 2012
Anatomy cross section from refl.in/1a Ref: BJA 99 (2): 159–69 (2007) refl.in/1b
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Superficial cervical plexus block. 20-30ml 0.25% ropivicaine along posterior border of sternocleidomastoid & anteriorly over incision site

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Minimise hypertension on extubation with GTN bolus

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GTN 50-100mcg #ref
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