PMID- 33505816
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20210130
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 12
IP  - 12
DP  - 2020 Dec 24
TI  - Anesthetic Considerations for Transcarotid Artery Revascularization: Experience 
      and Review of Forty Cases From a Single Medical Center.
PG  - e12250
LID - 10.7759/cureus.12250 [doi]
LID - e12250
AB  - Transcarotid artery revascularization (TCAR) procedure is a novel hybrid surgical 
      modality in treating carotid stenosis. Understanding the various steps of the 
      TCAR and the unique challenges involved in the anesthetic management is essential 
      for the successful conduct of anesthesia. In this article, we discuss the 
      overview of the key issues relevant to the anesthetic management and strategies 
      from our experience. We present the data on anesthetic management and outcomes of 
      40 patients who underwent TCAR procedure at our institute between June 2018 and 
      February 2020. Electronic medical records were retrospectively reviewed and 
      relevant demographic, clinical, and laboratory data were collected. All our 
      patients had general anesthesia with an endotracheal tube utilizing standard 
      American Society of Anesthesiology (ASA) monitoring along with intra-arterial 
      blood pressure monitoring and cerebral oximetry. The mean age of our patients was 
      73.6 +/- 7.58 years. Fifteen (37.5 %) patients had significant co-morbidities, thus 
      classified as ASA 4 and 10 (25%) patients were on at least three 
      antihypertensives (beta-blockers, calcium channel blockers, 
      angiotensin-converting enzyme inhibitors, loop diuretics, thiazides). Thirty-four 
      (85%) patients were considered to have symptomatic carotid stenosis which was the 
      predominant indication for the TCAR procedure. Patients who had episodes of 
      transient ischemic attack (TIA) or a cerebrovascular accident (CVA) documented by 
      a computerized tomography (CT) scan of the brain and/or residual weakness are 
      considered symptomatic. Thirty-six (90%) of our patients received a bolus dose of 
      0.2 - 0.4 mg of glycopyrrolate for maintaining heart rate of around 70 beats per 
      minute (BPM) and 38 (95%) received phenylephrine infusion during the carotid 
      clamp to maintain blood pressure between 140 and 160 mm Hg systolic or at 
      patients' baseline. Twenty-one (52.5%) patients needed antihypertensives such as 
      hydralazine ( 10-20 mg) or beta-blockers such as labetalol (10-20 mg) at the time 
      of emergence from anesthesia to mitigate hemodynamic response during extubation. 
      The mean blood loss was 74 ml +/- 33.19 ml, and none of our patients received blood 
      transfusion during the perioperative period. The mean duration of anesthesia was 
      202.6 +/- 27.85 minutes, and the mean length of hospital stay was 1.5 +/- 0.97 days. 
      A thorough preoperative examination with specific attention to the preoperative 
      neurological deficits and cardiopulmonary reserve is important for the meticulous 
      management of intraoperative hemodynamics. Intraoperative administration of 
      glycopyrrolate and the use of vasopressors to maintain optimal hemodynamics to 
      ensure cerebral perfusion during the perioperative period should be considered. 
      The anesthetic goals of carotid revascularization (TCAR) are perioperative 
      hemodynamic stability and early evaluation of neurological status in the 
      immediate postoperative period.
CI  - Copyright (c) 2020, Ankam et al.
FAU - Ankam, Abistanand
AU  - Ankam A
AD  - Anesthesia, Guthrie Robert Packer Hospital, Sayre, USA.
FAU - Kinthala, Sudhakar
AU  - Kinthala S
AD  - Anesthesia, Guthrie Robert Packer Hospital, Sayre, USA.
FAU - Madabhushi, Praneeth
AU  - Madabhushi P
AD  - Anesthesiology, Guthrie Robert Packer Hospital, Sayre, USA.
LA  - eng
PT  - Journal Article
DEP - 20201224
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7822093
OTO - NOTNLM
OT  - anesthetic management of tcar
OT  - cerebral oximetry for tcar
OT  - hemodynamic management for tcar
OT  - review of anesthesia for tcar
OT  - transcarotid artery revascularization (tcar)
OT  - treatment of carotid stenosis
COIS- The authors have declared that no competing interests exist.
EDAT- 2021/01/29 06:00
MHDA- 2021/01/29 06:01
PMCR- 2020/12/24
CRDT- 2021/01/28 05:43
PHST- 2021/01/28 05:43 [entrez]
PHST- 2021/01/29 06:00 [pubmed]
PHST- 2021/01/29 06:01 [medline]
PHST- 2020/12/24 00:00 [pmc-release]
AID - 10.7759/cureus.12250 [doi]
PST - epublish
SO  - Cureus. 2020 Dec 24;12(12):e12250. doi: 10.7759/cureus.12250.