CEREBRAL PROTECTION DURING CAROTID ENDARTERECTOMY

Carotid endarterectomy has assumed an increasingly important role in the definitive management of patients with cerebrovascular insufficiency syndromes whose lesions are located in the extracranial vasculature. With proper selection of cases and careful attention to details of intraoperative management, endarterectomy can be performed with low morbidity and with operative mortality approaching 1%. Since no unnecessary risks should be taken in these patients, especially those with transient cerebral ischemic attacks and asymptomatic carotid bruits, some method of monitoring the adequacy of cerebral blood flow or a reliable means of cerebral protection during endarterectomy must be employed if strokes are to be prevented and aggravation of neurological deficits is to be avoided.

Elsewhere in this issue (p 1023) White and associates report on the anesthetic management for carotid artery surgery. Their regimen includes hypercapnia, general anesthesia with halothane, spontaneous respiration, maintenance of each patient's normal blood pressure using phenylephrine if necessary, and