Anaesthesia for carotid surgery

Abstract: Carotid endarterectomy (CEA) is a surgical procedure to prevent strokes in patients with atheromatous disease at the carotid bifurcation. The effectiveness of CEA has been established in large clinical trials. Patients should have surgery performed within 2 weeks from the onset of symptoms. This timeframe presents a challenge to the anaesthetist and surgeon in risk stratifying and optimizing these high-risk patients for surgery. Optimization includes blood pressure (BP) control and use of antiplatelet and lipid-lowering therapy.CEA can be carried out under general anaesthesia (GA) or regional anaesthesia (RA) with the advantages and disadvantages of both techniques discussed. Understanding surgical technique and the implications for anaesthesia is important, specifically the use of carotid shunting, eversion technique and patch angioplasty. Cerebral perfusion monitoring can be used during CEA to reduce neurological morbidity and mortality. The gold standard remains an awake patient where sensory, motor and higher mental functions can be assessed continuously.Intraoperative and postoperative management may involve haemodynamic and neurological complications such as stroke, cerebral hyperperfusion syndrome, heart failure and myocardial infarction. Compromise to the airway can occur as a result of oedema or haematoma and the latter may require exploration in theatre.
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Authors: Tags: Vascular Anaesthesia Source Type: research

Related Links:

Authors: Attar A, Sayadi M Abstract INTRODUCTION: Currently, conflicting evidence exists among community-based studies as to whether Chronic kidney disease (CKD) is a Cardiovascular (CVD) risk equivalent. We aimed to evaluate the effect of CKD on CVD based on large trial results. METHODS: To perform a secondary analysis, we obtained the data of SPRINT trial from NHLBI Data Repository Center. 2646 subjects with baseline CKD and 6715 without CKD were enrolled. A composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes was considered as primary ...
Source: Iranian Journal of Kidney Diseases - Category: Urology & Nephrology Tags: Iran J Kidney Dis Source Type: research
ConclusionsIn this observational analysis of T2D and ASCVD, baseline β-blocker use was not associated with risks for severe hypoglycemia yet also was not associated with CV risk reduction over 3 years of follow-up, supporting a randomized examination of chronic β-blocker therapy in this patient population. (TECOS ClinicalTrials.gov number, NCT00790205).
Source: American Heart Journal - Category: Cardiology Source Type: research
In conclusion, high-dose NR induces the onset of WAT dysfunction, which may in part explain the deterioration of metabolic health. Towards a Rigorous Definition of Cellular Senescence https://www.fightaging.org/archives/2019/11/towards-a-rigorous-definition-of-cellular-senescence/ The accumulation of lingering senescent cells is a significant cause of aging, disrupting tissue function and generating chronic inflammation throughout the body. Even while the first senolytic drugs capable of selectively destroying these cells already exist, and while a number of biotech companies are working on the productio...
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
ConclusionsIn AF patients, there is underuse of GDT for non-AF comorbidities. The association between GDT use and outcomes was strongest in heart failure and obstructive sleep apnea patients where use of GDT was associated with lower mortality and less AF progression.
Source: American Heart Journal - Category: Cardiology Source Type: research
In patients with diabetes, where cardiovascular morbidity is highly prevalent, recent cardiovascular outcomes trials have identified therapies in the modern glucagon-like peptide 1 receptor agonist (GLP-1RA) and sodium-glucose cotransporter 2 inhibitor (SGLT2i) classes that significantly reduce cardiovascular events. A number of drugs in both classes have demonstrated reductions in the risk of the composite outcome of major adverse cardiovascular events (myocardial infarction, stroke, and cardiovascular death). In addition, SGLT2i drugs have a substantial impact on hospitalization for heart failure. Because GLP-1RA and SGL...
Source: Cardiovascular Endocrinology - Category: Cardiology Tags: Review Articles Source Type: research
We sought to analyze outcomes of women receiving balloon-expandable valves (BEV) or self-expanding valves (SEV) in contemporary transcatheter aortic valve implantation (TAVI). WIN TAVI (Women's INternational Transcatheter Aortic Valve Implantation) is the first all-female TAVI registry to study the safety and performance of TAVI in women. We compared women treated with BEV (n=408, 46.9%) versus those treated with SEV (n  = 461, 53.1%). The primary efficacy endpoint was the (VARC-2) composite of 1-year all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
ConclusionsThe prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre ‐hospital conditions.
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
Publication date: Available online 2 November 2019Source: Journal of EthnopharmacologyAuthor(s): Da-Wu Zhang, Shao-Li Wang, Pei-Li Wang, Jian-Peng Du, Zhu-Ye Gao, Cheng-Long Wang, Hao Xu, Da-Zhuo ShiAbstractEthnopharmacological relevanceFufang Chuanxiong capsule consists of Angelica sinensis radix and Chuanxiong rhizome, which are used in the traditional Chinese medicine for the treatment of coronary artery disease, and Xinyue capsule is composed of panax quinquefolius saponin extracted from leaves and stems of Panax quinquefolium L, which has the functions of anti-myocardial ischemia, improving myocardial energy metabolis...
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
Although attention has been paid to the relationship between malignant diseases and cardiovascular diseases, few data have been reported. Moreover, there have also been few reports in which the preventive factors were examined in patients with or without malignant disease histories requiring percutaneous coronary intervention (PCI). This was a retrospective, single-center, observational study. A total of 1003 post-PCI patients were divided into a malignant group, with current or past malignant disease, and a nonmalignant group. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, s...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research
CONCLUSION: Acute myocardial infarction and hypertrophic cardiomyopathy patients who were obese exhibited worse long-term outcomes than those without obesity. PMID: 31674878 [PubMed - as supplied by publisher]
Source: Perfusion - Category: Cardiovascular & Thoracic Surgery Authors: Tags: Perfusion Source Type: research
More News: Anesthesia | Anesthesiology | Angioplasty | Cardiology | Carotid Angioplasty | Carotid Endarterectomy | Clinical Trials | Heart | Heart Attack | Heart Failure | Intensive Care | Men | Neurology | Neurosurgery | Perfusion | Stroke