Intraoperative management: carotid endarterectomies

The management of anesthesia for patients undergoing carotid endarterectomy is challenging and dynamic. Effective management and good outcome requires the anesthesiologist's understanding of cerebral physiology, knowledge of neck anatomy, and understanding of the rapid pathophysiologic changes that occur during carotid artery manipulations. The anesthesiologist must be flexible in the management of patients, who frequently have underlying multiorgan pathology and cardiovascular compromise. Good communication between the anesthetic and surgical teams is needed to avoid irreversible debilitating consequences for the patient.