Factors Associated with Perioperative Complications during Carotid Endarterectomy

Abstract

Factors associated with perioperative complications during carotid endarterectomy. Anesth Analg 1982;61:631-7.Records from 166 cases of unilateral carotid endarterectomy were reviewed to investigate the association of certain preoperative and intraoperative factors with perioperative complications including hypertension and hypotension, neurologic deficit, myocardial infarction, and mortality. No myocardial infarctions occurred and mortality was zero.Complications associated with some of the study factors included postoperative hypertension and neurologic deficit. Postoperative hypertension occurred more frequently ( a ) in patients with poor preoperative blood pressure (BP) control (BP 2 170/95 torr) than in those with adequate control (BP < 170/95 torr) or normotension (52%. 35%, and 17%, respectively, p < 0.01 and, ( b ) when additional peripheral vascular disease was present (43% vs 25%. p < 0.05). The incidence of neurologic deficit was higher when hypertension developed after surgery (20%) than when patients remained normotensive (6%) or developed hypotension (O%, p < 0.05). Patients whose hypertension was poorly controlled had a greater incidence of transient neurologic deficit (23.8%) than patients with controlled hypertension (2.5%) or patients with normotension (1.5%, p < 0.01 1; permanent neurologic deficit occurred more frequently in those with bilateral disease on angiography than in those with unilateral disease (8.8% vs 1.2%, p < 0.05).

Anaesthesia and Hypertension

“…Patients with lesser degrees of untreated hypertension (diastolic pressures >90mmHg but <110mmHg), or those whose high arterial pressure was well controlled by antihypertensive drugs, showed no increase of postoperative morbidity compared with their nonnotensive counterparts (Goldman and Caldera, 1979). In specific areas of surgery, notably carotid endarterectomy (Asiddao et al, 1982), the pre-existence of inadequately controlled hypertension has been clearly shown to be associated with an increased frequency of both transient and permanent neurological deficit. Pre-existing hypertension has been shown to increase the occurrence of postoperative myocardial re-infarction in patients who had a history of previous myocardial infarction (Steen, Tinker and Tarhan, 1978).…”

Risk Factors of Postprocedural Hypotension following Carotid Artery Stenting

“…Although CEA has been a standard method of treatment for carotid artery stenosis, haemodynamic instability after CEA has been linked to surgical morbidity and mortality 4,5,6,7 . CEA -induced hypotension has been demonstrated to correlate with poor outcome, as extensively described in the literature 8,9,10 .…”

Pronounced unexplained preoperative tachycardia heralding serious cardiac events: a series of three cases

“…Although no data exist on the relationships between preoperative and intraoperative tachycardia, and preoperative tachycardia and complications, previous studies have found associations between preoperative and intraoperative BP, and preoperative BP and perioperative complications. [11][12][13] It is therefore possible that a similar relationship exists for preoperative and intraoperative HR. For preoperative tachycardia due to a known etiology (e.g., pain or anxiety), appropri-ately treating the causative factor should eliminate this association.…”