Medical Pharmacology Clinical Case: Anesthesia and Carotic Endarterectomy


A 78 year-old woman suffered from transient ischemic attacks (TIAs) in which she temporarily lost consciousness. Arteriography revealed a partial obstruction of the right common carotid artery by atherosclerotic plaques. Carotid endarterectomy was scheduled.

case author: Hugh S. Mathewson, M.D., Professor Emeritus, School of Allied Health, Department of Nurse Anesthesia, University of Kansas Medical Center
case editor: Michael Gordon, Ph.D. Associate Professor, University of Kansas Medical Center

What anesthetic procedure is indicated for this operation?
1. Regional anesthesia
2. general anesthesia, using ketamine (Ketalar) and high-dose opioids
3. general anesthesia, with induction using thiopental (Pentothal), succinylcholine (Anectine) for muscle paralysis, intubation and maintenance with isoflurane (Forane)/oxygen
4. any of the above procedures equally appropriate