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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
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