Benefits of using dexmedetomidine during carotid endarterectomy: A review

Area of Science:

• Anesthesiology
• Neurosurgery
• Cardiovascular Surgery

Background:

• Carotid endarterectomy (CEA) is recommended within 24-72 hours for acute ischemic stroke and recurrent transient ischemic attacks (TIAs).
• Patients undergoing CEA are often hemodynamically labile, risking accelerated hypertension during anesthesia induction and extubation.
• Preoperative avoidance of ACE inhibitors/ARBs can exacerbate perioperative hypertensive challenges.

Purpose of the Study:

• To evaluate the efficacy of dexmedetomidine in managing hemodynamic stability during carotid endarterectomy.
• To explore dexmedetomidine's role in attenuating hypertensive responses in major surgeries.

Main Methods:

• Literature search on PubMed and Google for studies on dexmedetomidine use in carotid endarterectomy under general and locoregional anesthesia.
• Keywords included: anesthesia, carotid endarterectomy, dexmedetomidine, hemodynamic control, perioperative hypertension.
• Investigated dexmedetomidine infusion for intubation response and stability in other major surgeries (CABG, craniotomies, bariatric, valve replacement).

Main Results:

• Dexmedetomidine provides effective central sympatholytic effect, ensuring good hemodynamic control.
• Demonstrated utility during induction, intraoperative management, and extubation phases of CEA.
• Applicable for managing hypertensive responses and ensuring stability in various major surgical procedures.

Conclusions:

• Dexmedetomidine is a valuable agent for hemodynamic management in carotid endarterectomy.
• Its sympatholytic properties facilitate stable anesthesia, reducing risks associated with perioperative hypertension.
• Supports the use of dexmedetomidine for enhanced patient safety in CEA and other major surgeries.