術中覚醒を目的とした頚動脈内膜切除術の麻酔

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  • Anesthesia for Forced Awareness During Carotid Endarterectomy.

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Neurologic defects due to cerebral ischemia are the most serious complications of carotid endarterectomy (CEA). Monitoring of cerebral function during general anesthesia is more complicated than during regional anesthesia. Other complications may be noted if regional anesthesia is selected, since the patient is alert during the operation.<br>Five cases of carotid endarterectomies were performed using a combination of cervical epidural anesthesia with light sedation and N2O-O2 general anesthesia.<br>The patient was forced awake by ceasing N2O prior to test carotid artery clamping process. Neurological functions were repeatedly assessed in the course of the test clamping and also when indicated throughout the operative procedure.<br>In three out of five cases, the operation was completed without any problems. Neurological disorders were suspected in the remaining two patients during test clamping. Supplemental circulatory shunting made it possible to complete the operation without severe complications in those two cases.<br>We concluded that this combined anesthesia is useful for monitoring the cerebral functions during CEA.

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