Carotid Endarterectomy

[TraumaNurse]

I was wondering how other anesthesia providers are doing CEAs? Awake with a cervical plexus block or GA? We do them with the cervical plexus block and I see there are some great advantages to this, but it can also make them very challenging. I am curious as to how others are doing them and what you feel are the advantages/disadvantages of each technique? Thanks.

[athomas91]

trauma - the ones i have done have been under general and utilizing the cerebral pulse oximeter to roughly just blood flow to the hemispheres prior to and during clamp time - i found it very useful....

the disadvantage that was cited to me against the awake version is that (haven't done it and can't attest to it) apparently the population (elderly) get really tired of having their head to one side and get the wiggles... let me know.

[jwk]

I've done them under general for many years, but I recently started working with a surgeon who does all of his under local with moderate sedation. He talks to the patient periodically during the case and will have the patient squeeze his hand from time to time as well. It has worked very well in the few that I have done this way. Minimal changes in vitals, no patient complaints.

One extremely important caveat - lidocaine with epi inadvertently injected directly into the carotid artery while injecting local is VERY impressive, and not in a good way.

[lapappey]

One extremely important caveat - lidocaine with epi inadvertently injected directly into the carotid artery while injecting local is VERY impressive, and not in a good way.

I'll bet.

[mwbeah]

80% of CEAs with the superficial cervical plexus block at my institution.

Mike

[Brenna's Dad]

One of our surgeons prefers the awake method after doing his own field block. I have done this twice, so obviously don't have a great deal of experience.. however, both times the patients got rather "wiggy" with the propofol gtt since our goal was to have them awake enough to follow commands. I ended up stopping the propofol gtt and doing pure conscious sedation. Worked great after that. In this age group, most patients when awake understand the importance of keeping still while the surgeon is operating.

[emergence artist]

At my institution (literally and figuratively), almost all CEA's done via GA with EEG monitoring. It can be a real b@!%h. We typically have high risk patients too.