Faculty Collaboration Database

Preoperative volume expansion improves tolerance to carotid artery cross-clamping during endarterectomy. Neurosurgery 1998 Aug;43(2):222-6; discussion 226-8

Date

08/08/1998

Pubmed ID

9696073

DOI

10.1097/00006123-199808000-00016

Scopus ID

2-s2.0-0031879818 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

OBJECTIVE: The benefit of carotid endarterectomy for carotid artery stenosis relates to both appropriate patient selection and careful surgical technique. Critical to the latter is the ability to afford intraoperative neuroprotection during carotid cross-clamping, although the optimal strategy to assure this protection remains debated. This report describes the impact of adding preoperative colloid volume expansion to a surgical algorithm that includes electroencephalographic (EEG) monitoring and barbiturate-induced burst suppression for EEG lateralization refractory to hypertension.

METHODS: The incidence of ischemic EEG change during carotid cross-clamping was observed. The results of an initial series of patients (n = 45) reported before incorporation of volume expansion were compared with the results of the current series (n = 155) of carotid endarterectomies, which included preoperative volume expansion with 6% hetastarch (500 or 1000 cc).

RESULTS: With preoperative volume expansion, there was a 40% decrease in the incidence of EEG lateralization during carotid cross-clamping (17.4 versus 28.9%, P < 0.05) and a 63% decrease in the EEG lateralization refractory to induced hypertension (5.8 versus 15.6%, P < 0.05). The combined perioperative stroke and death rate was 1.3%.

CONCLUSION: These results support the use of preoperative colloid volume expansion in carotid endarterectomy as a means of increasing the cerebral tolerance to carotid cross-clamping.

Author List

Gross CE, Bednar MM, Lew SM, Florman JE, Kohut JJ

Author

Sean Lew MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adjuvants, Anesthesia
Adult
Aged
Aged, 80 and over
Brain Ischemia
Carotid Stenosis
Dominance, Cerebral
Electroencephalography
Endarterectomy, Carotid
Female
Humans
Hydroxyethyl Starch Derivatives
Intraoperative Complications
Male
Middle Aged
Monitoring, Intraoperative
Neuroprotective Agents
Pentobarbital
Plasma Substitutes
Plasma Volume
Risk Factors