Anesthesia Management in the Surgical Treatment of Carotid Artery Disease
Özet
Anesthesia management in the surgical treatment of carotid artery disease, primarily carotid endarterectomy (CEA), plays a critical role in minimizing perioperative morbidity and mortality. Pre-anesthesia evaluations focus on maintaining current pharmacological treatments, such as aspirin, and thoroughly investigating comorbidities like coronary artery disease and hypertension. Intraoperative monitoring is essential, utilizing electrocardiography, invasive blood pressure measurements, and specialized cerebral monitoring techniques—such as electroencephalography or cerebral oximetry—to detect cerebral ischemia and determine the necessity of a surgical shunt. While both general and regional anesthesia are viable options for CEA, the optimal method remains a subject of ongoing debate. General anesthesia provides secure airway control, prevents patient anxiety, and is highly comfortable for the surgeon, but it can limit cerebral autoregulation. Conversely, regional anesthesia—including superficial or deep cervical blocks—offers distinct advantages, such as stable hemodynamics, reduced need for blood transfusions, lower rates of postoperative pneumonia, and the invaluable ability to conduct continuous neurological examinations on an awake patient. Ultimately, maintaining hemodynamic stability and implementing effective neurological monitoring are the most crucial elements for successful anesthetic management in carotid surgery, regardless of the technique chosen.
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