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If you wish to respond to a paper or other item already published in the BJA, please go to the abstract/full text version of that item and click on the link "E-Letters: Submit a response to the article".

Electronic Letters to:

Review Articles:
M. D. Stoneham and J. P. Thompson
Arterial pressure management and carotid endarterectomy
Br. J. Anaesth. 2009; 102: 442-452 [Abstract] [Full text] [PDF]
*E-letters: Submit a response to this article

Electronic letters published:

[Read E-letter] Carotid endarterectomy - pressure to proceed...
James Nielsen   (1 April 2009)

Carotid endarterectomy - pressure to proceed... 1 April 2009
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James Nielsen

Send letter to journal:
Re: Carotid endarterectomy - pressure to proceed...

Thanks to Stoneham and Thompson for their thoughtful review on arterial pressure management in carotid endarterectomy.

Particularly noteworthy was their reference to guidelines which advocate surgery within 48 hours of a TIA. The authors note that patients at that time are likely to be even more hypertensive, have arterial pressure under anaesthesia that is even more labile, and have higher risk of perioperative stroke.

This means higher risk patients will be presenting with less time for optimization. This has relevance beyond blood pressure control - what of the patient on potent antiplatelet agents (another head - and neck - of the clopidogrel Hydra!)?

This guideline may also exacerbate the problem of availability of postoperative monitoring. We risk being pressured to anaesthetize 'higher pressure' patients despite bed pressures limiting postoperative care...!

Conflict of Interest:

None declared