ANESTHESIA FOR CAROTID STENTS
Anesthetic Choice:
MAC:
-Surgeons have requested minimal Versed or narcotics at
beginning of case!
-These patients will need to be awake during the critical parts
of the case, so these pts are more lightly sedated.
-PROPOFOL ONLY IN BEGINNING OF CASE
-Use propofol bolus injections and infusion for arterial line
insertion, Foley insertion, and groin access. Once groin
access is obtained, the surgeon will want to have patient
breath hold for arteriograms, therefore the patient needs
to be awake and cooperative.
Surgeon has requested that no sedation be given at the
end of the case after deployment of the stent. Research is
showing that sedation at the end of the case can be
contributory to hypotension. For this reason if you feel the
patient needs sedation or is in pain, please evaluate each
case individually with surgeon regarding analgesia or
possible sedation.
Position:
Both arms tucked, in case need to open
Place “oogah” horn in hand opposite operative side,
(wrap in with kerlix so pt doesn’t drop it) patient can then
squeeze it on command
Make sure all wires and nasal cannula tubing out of C-Arm
beam
Be sure metal gown snaps removed
Lines:
-need 2 IV
-arterial line
Revised 6/05
Brewer
Ragab
Pharmacology:
-Heparin, based on surgeon and ACT
-Phenlyephrine(bolus and infusion)—necessary with
balloon angioplasty, preferred over Dopamine by surgeon
during case. If further support needed in PACU, will
switch to Dopamine.
-Robinul/Atropine REQUIRED before balloon angioplasty
(Robinul 0.2-0.4mg: Atropine 0.4-0.8mg)
Tips:
IN ROOM 26, PLEASE HAVE ALL WIRES AND LINES OFF RIGHT
SHOULDER, OR USE THE FOOT MOUNTED MONITORING
MODULE ON AVANCE MACHINE.
-Access for sheath and catheters is usually groin, may be
brachial. CONT’D.
-Heparin dosing per surgeon, with frequent ACT, at least
q20-30 min
-MUST USE ANTICHOLINERGIC PRIOR TO BALLOON
ANGIOPLASTY!!! Will see profound bradycardia to
asystole with balloon if not pre-treated.
*Avoid beta blockers if at all possible, will enhance this
problem*
-Need patient normotensive or a little above normal
before balloon angio to assure collateral circulation. After
balloon angio, may see Profound Hypotension therefore
pretreatment with phenlyephrine bolus right before angio
helpful
-Will do balloon angioplasty of carotid 1-2 times, during
this time, patient is VERY uncomfortable, need to warn
patient before balloon inflated, and help them hold head
still.
-Following angioplasty will have patient squeeze horn in
contralateral hand, and wiggle toes as well as assess
orientation
-Will shoot MedRad automatic contrast injector, during
these angiographies, important that patient not talk,
breathe, or move, that’s one reason why they want patient
awake
Revised 6/05
Brewer
Ragab
-Be aware that there can be significant blood loss at groin
site—may be hidden in drapes. If hypotension does not
respond to vasopressors, consider anemia
-Rare instances of Extreme hypertension may require NTG
gtt
Revised 6/05
Brewer
Ragab