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British Journal of Anaesthesia, 2001, Vol. 87, No. 4 641-644
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia

Case Reports

Blood pressure manipulation during awake carotid surgery to reverse neurological deficit after carotid cross-clamping

M. D. Stoneham and O. Warner

Nuffield Department of Anaesthetics, Level 1, Oxford Radcliffe NHS Hospital, Headington, Oxford OX3 9DU, UK*Corresponding author

We describe the management of three patients undergoing awake carotid surgery who developed signs of cerebral ischaemia after carotid cross-clamping. Drug treatment to increase arterial blood pressure above baseline reversed the neurological deficit and an internal carotid artery shunt was not needed. Shunt insertion is less frequent with regional rather than general anaesthesia, and blood pressure control can reduce this even more. Coincidentally, one of the patients, who gave a history of angina of effort after walking 100 m, complained of chest pain after cross-clamp release. This was treated successfully with sublingual nitroglycerin before ST segment changes became apparent on the ECG. These reports suggest that regional anaesthesia for carotid surgery allows potential complications to be identified earlier than under general anaesthesia using reports from the patient, so that treatment may be modified to prevent morbidity and even mortality.

Br J Anaesth 2001; 87: 641–4


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