Cerebral protection with thiopentone during combined carotid endarterectomy and clipping of intracranial aneurysm

• Published in: Anaesthesia and intensive care Vol. 30; no. 2; pp. 219 - 222
• Main Authors: MCCONKEY, P. P, KIEN, N. D
• Format: Journal Article
• Language: English
• Published: Edgecliff Anaesthesia and Intensive Care 01.04.2002; Sage Publications Ltd
• Subjects: Anesthesia; Anesthesia depending on type of surgery; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Brain Ischemia - diagnosis; Brain Ischemia - etiology; Brain Ischemia - prevention & control; Carotid Artery, Internal - surgery; Carotid Stenosis - complications; Carotid Stenosis - surgery; Constriction; Electroencephalography; Endarterectomy, Carotid; Female; Humans; Hypnotics and Sedatives - administration & dosage; Intracranial Aneurysm - complications; Intracranial Aneurysm - surgery; Intraoperative Complications; Medical sciences; Middle Aged; Neuroprotective Agents - administration & dosage; Neurosurgery; Thiopental - administration & dosage; Internal carotid; Aneurysm; Stenosis; Cardiovascular disease; Arterial disease; Vascular disease; Clip; Prevention; Ischemia; Surgery; Complication; Barbiturates; Endarteriectomy; Cerebrovascular disease; Human; Intracranial; Nervous system diseases; Thiopental sodium; General anesthesia; Neuroprotective agent; Artery; Cerebral disorder; Case study; Clamping(surgery); Carotid; Central nervous system disease; Brain (vertebrata)
• ISSN: 0310-057X; 1448-0271
• DOI: 10.1177/0310057X0203000217

We report a case of carotid endarterectomy and clipping of an ipsilateral internal carotid artery aneurysm in a patient with complete contralateral carotid stenosis. The patient developed an ischaemic electroencephalographic (EEG) tracing on temporary carotid clamping and bypass shunt was contraindicated. We used thiopentone titrated to EEG burst suppression for pharmacological cerebral protection during the subsequent prolonged carotid clamp necessary for carotid endarterectomy. We review the use of thiopentone for this purpose, in particular the evidence for efficacy, mechanism of action and optimal dosage and timing of administration.