title: Increased oxygen administration during awake carotid surgery can reverse neurological deficit following carotid cross-clamping.
abstract: We describe the management of two patients undergoing awake carotid surgery who developed signs of cerebral ischaemia following cross-clamping of the internal carotid artery. Administration of oxygen 100% with a close-fitting anaesthetic facemask reversed the neurological deficit, avoiding the need for insertion of an internal carotid artery shunt. Thus, the incidence of shunt insertion, which is reduced by the use of regional rather than general anaesthesia, could be reduced further by supplementary oxygenation. The possible mechanism and implications are discussed.
authors.affiliation: Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK. mark.stoneham@nda.ox.ac.uk
authors.forename: M D
authors.initials: MD
authors.lastname: Stoneham
authors.forename: T
authors.initials: T
authors.lastname: Martin
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy*; D002343:Carotid Artery, Internal / Q000503:physiopathology*; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D007431:Intraoperative Complications / Q000628:therapy*; D008297:Male; D009407:Nerve Block; D010102:Oxygen Inhalation Therapy