[Perioperative management for carotid endoarterectomy with induced mild hypothermia: a case report]

We report perioperative management for carotid endoarterectomy with induced mild hypothermia in a patient with severe stenosis of the bilateral carotid arteries. The patient was a 47 year-old male with familial hyperlipidemia and history of coronary artery bypass surgery. Angiography revealed severe stenotic lesions of the right internal carotid artery (ICA) and total occlusion of the left ICA. Endoarterectomy for the right ICA was planned. Anesthesia was induced and maintained with fentanyl, midazolam, pancuronium and sevoflurane. Electroencephalogram and near-infrared cerebral oxymetry were employed for monitoring intraoperatively. Temporary shunting was used during clamping of the right carotid artery because collateral blood flow could not be expected due to total occlusion of the left ICA. Furthermore, mild hypothermia down to 34 degree C was induced for brain protection with the use of a cooling blanket. After the surgery, the patient was transferred to ICU under deep anesthesia and controlled ventilation. Anesthesia was lightened gradually after rewarming to prevent postoperative shivering. The patient left ICU on the second postoperative day without any neurological deficits.