title: [Total intravenous anesthesia with propofol, fentanyl and ketamine for carotid endarterectomy under somatosensory evoked potential monitoring--combination with intraoperative hypothermia].
abstract: We reported anesthetic management combined with hypothermia for carotid endarterectomy under somatosensory evoked potential monitoring. Anesthesia was induced by propofol, fentanyl and ketamine, and maintained by infusion of propofol and ketamine and intermittent injections of fentanyl. Perioperative hypothermia was induced by gradually reducing the temperature of a circulating water mattress underneath the body to 15 degrees C. Additionally, somatosensory evoked potential monitoring was performed and recordings were obtained immediately after induction of anesthesia, and before as well as during cross-clamping of the internal carotid artery. Rectal temperature was reduced to 33.7 degrees C when cross-clamping of carotid artery was carried out, but major changes between before and during the procedure was not observed. All procedures were done uneventfully and gradual rewarming was accomplished by electric blanket. No neurological deficits were observed following recovery from anesthesia. Total intravenous anesthesia with propofol, fentanyl and ketamine may be useful for carotid endarterectomy under hypothermia and somatosensory evoked potential monitoring. This method may provide neuronal protection against ischemia injuries induced by cross-clamping of the carotid artery.
authors.affiliation: Division of Anesthesiology, Okinawa Prefectural Miyako Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Fujimine
authors.forename: M
authors.initials: M
authors.lastname: Kakinohana
authors.forename: N
authors.initials: N
authors.lastname: Tomiyama
authors.forename: Y
authors.initials: Y
authors.lastname: Okuda
mesh_terms: D000368:Aged; D000771:Anesthesia, Intravenous; D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D016894:Endarterectomy, Carotid; D005073:Evoked Potentials, Somatosensory; D005283:Fentanyl; D006801:Humans; D007036:Hypothermia, Induced; D007649:Ketamine; D008297:Male; D016343:Monitoring, Intraoperative; D015742:Propofol
chemical_list: D000778:Anesthetics, Dissociative; D018686:Anesthetics, Intravenous; D007649:Ketamine; D005283:Fentanyl; D015742:Propofol