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BJA Advance Access originally published online on February 20, 2009
British Journal of Anaesthesia 2009 102(4):442-452; doi:10.1093/bja/aep012
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 BJA: April 2009
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Arterial pressure management and carotid endarterectomy

M. D. Stoneham1,* and J. P. Thompson2

1 Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford OX3 9DU, UK
2 University of Leicester and University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester LE1 5WW, UK

* Corresponding author. E-mail: mark.stoneham{at}nda.ox.ac.uk

Acute perioperative changes in arterial pressure occur frequently, particularly in patients with cardiovascular disease or those receiving vasoactive medications, or in relation to certain cardiovascular surgical procedures. Both hypo- and hypertension are common in patients undergoing carotid surgery because of unique patho-physiological and surgical factors. Poor arterial pressure control is associated with increased morbidity and mortality after carotid endarterectomy, but good control of arterial pressure is often difficult to achieve in practice. New guidelines have emphasized the benefits of performing carotid surgery urgently in patients with acute neurological symptoms. This strategy may make perioperative arterial pressure control more challenging. However, few specific data are available to guide individual drug therapy. The incidence, implications, and aetiology of haemodynamic instability associated with carotid surgery are reviewed, and some recommendations made for its management. Close monitoring and titration of therapy are probably the most important considerations rather than specific choice of agents.

Keywords: anaesthesia, general; anaesthetic techniques, regional; arterial pressure, hypertension; complications, cerebral ischaemia; complications, hypertension; surgery, endarterectomy


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Carotid endarterectomy - pressure to proceed...
James Nielsen
British Journal of Anaesthesia, 1 Apr 2009 [Full text]

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