Propofol EEG burst suppression in carotid endarterectomy.
BACKGROUND
The results of randomized trials indicate that carotid endarterectomy, performed with a low morbidity-mortality perioperative risk, is the best therapeutic option both for patients with high-grade symptomatic and asymptomatic stenosis. Since the main operative risk is represented by embolic or hemodynamic cerebral ischemia, it appears necessary to maintain an adequate intraoperative cerebral blood flow and to carry out a meticulous endarterectomy.


METHODS
On the basis of these considerations we prospectively studied a series of 100 consecutive patients operated on for high-grade carotid stenosis, by using a protocol based on: 1) an accurate selection of patients for surgery; 2) meticulous surgical technique without any shunt; 3) perioperative cerebral protection by barbiturate or propofol; 4) pre- and postoperative medical treatment of risk factors. All patients of our series performed preoperatively brain CT scan, transcranial Doppler, carotid duplex scanning, four vessel angiography, brain 99mTc-HMPAO SPECT. Eighty-two patients had symptomatic carotid stenosis ranged between 70 and 90%, 18 had carotid stenosis higher than 90%.


RESULTS
In this series there have been one postoperative death due to myocardial infarction and one major stroke.


CONCLUSIONS
We think that this protocol can significantly minimize risks of endarterectomy and probably maximize the benefits of surgery, also in patients with asymptomatic high-grade carotid stenosis.
D'Angelo
V
V
Department of Neurosurgery, Casa Sollievo della Sofferenza, Hospital, IRCCS, San Giovanni Rotondo (Foggia), Italy.
Catapano
G
G
Bozzini
V
V
Catapano
D
D
De Vivo
P
P
Del Gaudio
A
A
Ciritella
P
P
Simone
P
P
D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000601:surgery*; D016893:Carotid Stenosis / Q000188:drug therapy* / Q000601:surgery*; D004569:Electroencephalography; D004691:Endarterectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D011182:Postoperative Care; D011300:Preoperative Care; D015742:Propofol / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence
D018696:Neuroprotective Agents; D015742:Propofol