Anesthesia for Carotid Surgery.ppt

Anesthesia for Carotid Surgery R1胡念 之 Patient Profile Name: 陳阿檜 Sex: female Age: 49y/o Admission date: 93/12/03 C.C: Paroxysmal right side limbs shaking followed by right-sided transient weakness since 4 weeks ago Present Illness This 59 y/o female has a history of H/T and DM under regular medication for several years. Baseline BP: 140/80 mmHg She had TIA in 92/06 and recovered completely. 4 weeks ago, she started to had paroxysmal right-sided shaking limbs followed by right-sided transient weakness, dysarthria and dysphagia which would recover in a few seconds were noted Admitted to NTUH on 12/03. Image Study: pre-op Long segmental general narrowing diminished flow are noted at the distal right ICA. Diffuse narrowing with poor perfusion is noted at the bilateral ACAs and MCAs, more severe at the right side. Diagnosis Treatment Moyamoya disease with PC-AC and PC-MC collateral; bilateral ICA narrowing Scheduled EC-IC bypass (L’t STA and MCA branch anastomosis) on 12-08 Image Study: post-op Anastomosis between left superficial temporal artery and left MCA posterior frontal branch as compared with prior ECA study. Anesthesia of carotid surgery Preoperative Concerns Anesthetic Technique Cerebral Monitoring and protection Postoperative Concerns Pre-operative evaluation and management Central nervous system: Pre-operative neurological deficits Cardiovascular system: 1. CAD is present in about 20±40% of patients undergoing CEA 2. silent CAD: most influenced factor of long-term prognosis 3. CEA: intermediate cardiac risk procedure Best Pract Res Clin Anaesthesiol (14) 2000 BP control: avoid hypotension CPP = MAP - ICP Continued: β-blocker / calcium channel blocker ( heart protection) Discontinued: ACEI (lead to hypotension in combination with anesthesia agents) Peri-op Anaesthesia Care Goal: the protection of cerebral function prevent cerebral ischemia minimize risk for myo