Wake-up test after carotid endarterectomy for combined carotid-coronary artery surgery: a case series.
OBJECTIVE
In combined carotid-coronary artery surgery, it is important to determine patients' neurologic status after carotid endarterectomy (CEA). An initial stroke could be exacerbated by cardiopulmonary bypass required for coronary artery bypass graft (CABG) surgery. Various monitoring methods (eg, electroencephalogram) have been used to reduce neurologic deficits during CEA under general anesthesia. However, none of the methods of determining neurologic status of patients are ideal during the time between the end of CEA and the beginning of CABG surgery. In this study, patient's neurologic status was assessed after CEA with a wake-up test to identify stroke before CABG surgery.


METHODS
A prospective nonrandomized case series.


METHODS
Single institution, university hospital.


METHODS
Forty-four patients with carotid artery stenosis and coronary artery disease underwent combined carotid-coronary artery surgery.


METHODS
After CEA, propofol and remifentanil anesthesia was discontinued, the wake-up test was performed, and then anesthesia was reinstituted for CABG surgery.


RESULTS
A total of 48 wake-up tests were performed in 43 patients. Two wake-up tests were performed in each of the 5 patients who underwent bilateral CEA. Postoperative stroke were seen in 2 patients. In the first patient, despite a normal wake-up test, the stroke occurred in the cerebral hemisphere contralateral to the CEA, and the patient recovered within 12 days. In the second patient, there was a positive wake-up test after CEA, and he recovered within 3 days. One patient died postoperatively because of ventricular failure.


CONCLUSIONS
Although this is a case series, the authors believe that performing a neurologic examination using a wake-up test may make a contribution and increases the safety of combined surgical procedures in patients with coronary and carotid artery disease.
Department of Anesthesiology, Başkent University Adana Teaching and Medical Research Center, Adana, Turkey. aydaturkoz@yahoo.com
Ayda
A
Türköz
Riza
R
Türköz
Oner
O
Gülcan
Mesut
M
Sener
Tarik
T
Kiziltan
Esra
E
Calişkan
Nesrin
N
Bozdoğan
Gülnaz
G
Arslan
D002315:Cardiopulmonary Bypass / Q000379:methods; D016893:Carotid Stenosis / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D020521:Stroke / Q000517:prevention & control; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology*