| Carotid endarterectomy without shunt: the role of cerebral metabolic protection. | |
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MedLine Citation:
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PMID: 16354546 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The optimal method to protect the brain from hemodynamic ischemia during carotid endarterectomy (CEA) remains controversial. This study reports our experience with induced arterial hypertension and selective etomidate cerebral protection in a cohort of patients who underwent CEA without shunting and continuous electroencephalography (EEG) monitoring. METHODS: We reviewed retrospectively 102 consecutive CEAs performed in 102 patients with routine EEG monitoring and general anesthesia between March 1998 and October 2002. There were 65 (66%) symptomatic and 37 (34%) asymptomatic individuals. A protocol of induced arterial hypertension against EEG ischemic changes during carotid artery cross clamping was followed. Only patients with EEG changes refractory to induced hypertension went into etomidate-induced burst suppression. RESULTS: EEG changes were classified as mild, moderate and severe. Twenty patients (19.6%) developed asymmetric EEG changes, of which the great majority were mild and moderate (75%, p< 0.05). Seven patients with moderate (n=3) and severe (n=4) EEG changes needed etomidate cerebral protection. There were no mortalities and only one stroke (0.98%) is reported in the series. The morbidity rate was 6.8% and included transient cranial nerve palsies (n=5) and wound hematoma (n=1). CONCLUSIONS: Carotid endarterectomy can be safely performed with EEG monitoring and selective induced arterial hypertension and etomidate cerebral protection. Our results suggest that this method may be a good alternative for shunting and its inherent risks. |
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Authors:
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Miguel A Melgar; Nitin Mariwalla; Hassan Madhusudan; Martin Weinand |
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Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: Neurological research Volume: 27 ISSN: 0161-6412 ISO Abbreviation: Neurol. Res. Publication Date: 2005 Dec |
Date Detail:
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Created Date: 2005-12-15 Completed Date: 2006-03-29 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7905298 Medline TA: Neurol Res Country: England |
Other Details:
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Languages: eng Pagination: 850-6 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA. mmelgar@tulane.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Anesthetics, Intravenous / administration & dosage, therapeutic use* Anticoagulants / therapeutic use Blood Pressure Carotid Stenosis / complications, surgery*, ultrasonography Cohort Studies Constriction Electrocardiography Electroencephalography Endarterectomy, Carotid / methods* Etomidate / administration & dosage, therapeutic use* Female Follow-Up Studies Hemodynamics Heparin / therapeutic use Humans Intracranial Embolism / etiology, prevention & control* Intraoperative Period Male Middle Aged Monitoring, Intraoperative Myocardial Ischemia / complications Neuroprotective Agents / administration & dosage, therapeutic use* Retrospective Studies Risk Factors Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Anesthetics, Intravenous; 0/Anticoagulants; 0/Neuroprotective Agents; 33125-97-2/Etomidate; 9005-49-6/Heparin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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