carotid endarterectomy...Patient not moving right side?

After carotid endarterectomy,when patient unable to move one side.."it is STROKE until proven otherwise"

For carotid endarterectomy, most centers report a perioperative stroke rate of between 3 and 5 per cent.

The incidence of perioperative stroke is highest for patients with stroke, lower for patients with transient ischemic attack, and lowest in asymptomatic patients.

Neurologic deficits occur most commonly in patients with poorly controlled preoperative hypertension or in those with hypertension or hypotension postoperatively.

Extremes of blood pressure that are outside the range of autoregulation of cerebral perfusion can contribute to cerebral ischemia. But most strokes will be surgical complications. (1)

Per Sabiston, (Textbook of Surgery, 2001, p 1348), “neurologic deficits within the first 12 hours of operation are almost always the result of thromboembolic phenomena stemming from the endarterectomy site or damaged internal, common, or external carotid arteries.”

It is prefered not to extubate the carotid TEA patient until he proves he is awake and can move the contralateral extremities. If there is a stroke, you need only to give more drugs to resume anesthesia,allowing surgical re-exploration...

( 1)Per Miller’s Anesthesia

Comments

Things to Avoid in Anesthesia for Pregnant with Pulmonary hypertension

Anesthesia for Pregnant woman with Pulmonary Hypertension is a real challenge for anesthesiologist. It is very crucial to remember the pathophysiology of pulmonary hypertension in pregnant women and to avoid some practices that will worsen the cardiac status. 1-Avoid single shot spinal anesthesia. Some authorities consider pulmonary hypertension as absolute contraindication for single shot spinal anesthesia specially in patients with NYHA III ,IV. Spinal anesthesia causes major hemodynamic instability(decrease SVR, decrease VR, decrease in CO) The preferred neuroaxial techniques are (epidural anesthesia and CSE with minimal spinal dose) 2-Avoid PAC. Pulmonary Artery catheters insertion may lead to pulmonary artery rupture or thrombosis. TEE is better cardiac monitor/Arteial line is mandatory. 3-Avoid Nitrous oxide in gas mixture.N2O increase the PVR 4-If MV to be started, avoid High TV and PEEP 5-Avoid Oxytocin Boluses, or rapid administration of Pitocin. Oxytocin causes ...

power injectable peripherally inserted central catheters

Clinical experience with power injectable peripherally inserted central catheters in intensive care patients Introduction In intensive care units (ICU), peripherally inserted central catheters (PICC) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome by the use of power-injectable catheters . Method We have retrospectively reviewed all the power injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. Results We have collected 89 power injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related blood stream infection. Non-infective complications ...

Lumbar and thoracic epidural in Pediatrics-Technical aspect

The midline approach is most commonly used. The ligamentum flavum is considerably thinner and less dense in infants than in older children and adults. This makes recognition of engagement in the ligament more difficult and requires both extra care and slower, more deliberate passage of the needle to avoid subarachnoid puncture. The angle of approach to the epidural space is slightly more perpendicular to the plane of the back than in older children and adults, owing to the orientation of the spinous processes in infants and small children. The loss of resistance technique should be used, but only with saline, not air. There are several reports of venous air embolism in infants and children when air was used to test for loss of resistance Use a short (5 cm) 18-gauge Tuohy needle and a 20- or 21-gauge catheter in infants and children. Epidural kits specifically for infants and children are available Maximum of 0.4 mg/kg/hr of bupivacaine after the initial block is estab...

sedationstation

Search This Blog