Control of postcarotid endarterectomy hypotension with baroreceptor blockade

The reported incidence of hypotension after carotid reconstruction ranges from 21 to 50 percent. To evaluate baroreceptor dysfunction, 283 carotid reconstructions were studied. During 181 consecutive reconstructions, a transcutaneous Teflon catheter was positioned intraoperatively at the carotid bifurcation for postoperative injection of lidocaine as necessary. Of 283 reconstructions, 210 (74 percent) were not followed by hypotension. In the remaining 73 (26.5 percent), hypotension (systolic blood pressure less than 100 mm Hg) was seen. In 14 of the 73 cases of hypotension, vasoactive drugs, atropine, or a fluid bolus was administered with variable responses. In 27 of the 73, no treatment was instituted. In the remaining cases of hypotension, treatment consisted of 1 to 2 ml of lidocaine administered through the catheter. A prompt increase in systolic blood pressure from 93 to 139 mm Hg (means) within 30 minutes of treatment occurred in 29 of the 32 cases (91 percent). These data currently support routine catheter placement.