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British Journal of Anaesthesia, 2004, Vol. 92, No. 3 321-323
© 2004 The Board of Management and Trustees of the British Journal of Anaesthesia

Editorial I

‘It ain’t what you do; it’s the way that you do it ...’: reducing haemodynamic instability during carotid surgery

Mark D. Stoneham1

1 Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK E-mail: mark.stoneham{at}nda.ox.ac.uk

The first 150 words of the full text of this article appear below.

Some 10% of patients with a symptomatic internal carotid artery stenosis greater than 70% suffer a stroke every year. Of these, approximately one-third die, one-third recover, and one-third suffer significant residual neurological impairment.1 Carotid endarterectomy (CEA) reduces the risk of stroke in such symptomatic patients,2 although not in those with lesser stenoses, or near-occluded carotid disease. Thus, rather like the management of hypertension, the operation does not cure the patient of their disease, but is performed to prevent a life-threatening complication. Additionally, the complication rate of the procedure is high, so the stakes are high and, perhaps more than many other procedures, clinicians involved in carotid surgery tend to have dogmatic views regarding the anaesthetic and surgical techniques they are prepared to use.

Whilst the primary indication for surgery is neurological symptoms, much of the morbidity and mortality of the operation is cardiovascular in origin. Overall, the incidence of serious . . . [Full Text of this Article]


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