Below is an anaesthetic recipe for carotid endarterectomy under general anaesthetic. They can also be performed under regional.
Pre-op
- All of these patients have cardiovascular disease
- Note BP
- Note pre-existing neurological deficits
- Anti-platelets always continue
Peri-op
- Lines
- 18G cannula
- Arterial line – awake
- Drugs
- Metaraminol infusion titrated to maintain MAP within 20% of normal
- Short acting opiate – remifentanil ideal
- Small amount of propofol
- Atracurium
- Anti-emetics
- Head end may be distant- long circuit on anaesthetic machine
- Either turn table after induction, or have someone to squeeze the bag
- RAE tube
- Low normal etCO2 assuming lung disease
- Heparin when asked by surgeons/ a few minutes before clamping
- Aim for fast smooth emergence
- Allows rapid neurological assessment
- Aim to avoid coughing
Post-op
- Agree target BP range with surgeons
- May require HDU for BP control in either direction
Anaesthetic Recipes 