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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
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Anesthetic management of carotid endarterectomy: an update from Italian guidelines

Sergio Bevilacqua1, Giulia Ticozzelli2, Massimiliano Orso3

  • 1Department of Anesthesia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.

Journal of Anesthesia, Analgesia and Critical Care
|June 29, 2023
PubMed

Insights

This review found that anesthesia and neurological monitoring improve outcomes for carotid endarterectomy. Evidence is insufficient for heparin reversal, but postoperative blood pressure monitoring is suggested.

Area of Science:

  • Neurosurgery
  • Vascular Surgery
  • Anesthesiology

Background:

  • Carotid endarterectomy is a procedure to prevent stroke.
  • Current guidelines require updates on perioperative management.
  • This review focuses on anesthesia, monitoring, heparin reversal, and blood pressure management.

Purpose of the Study:

  • To systematically review the latest evidence on key aspects of carotid endarterectomy.
  • To provide evidence-based recommendations for clinical practice.

Main Methods:

  • Systematic review of studies published between January 2016 and October 2020.
  • Searched Medline/PubMed and Cochrane Library databases.
  • Included systematic reviews, meta-analyses, randomized controlled trials, and observational studies.

Main Results:

  • All anesthesia types and neurological monitoring methods are associated with improved outcomes.
  • Insufficient evidence exists to support routine heparin reversal post-surgery.
  • Low-level evidence suggests postoperative blood pressure monitoring is beneficial.

Conclusions:

  • Anesthesia and neurological monitoring are crucial for positive carotid endarterectomy outcomes.
  • The role of heparin reversal remains unclear due to limited evidence.
  • Postoperative blood pressure management is recommended despite low evidence levels.
Abstract

Keywords:
AnesthesiaBlood pressure monitoringCarotid endarterectomyGuidelinesHeparin reversalIntraoperative cerebral monitoringRecommendations

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