Hemodynamic Stability during Carotid Artery stenting Under General Anesthesia in Elderly
Patients with a High Grade Carotid Artery Stenosis

, Sang Hyo Kim; , Chul Bum Cho; , Won Il Joo; , Chung Kee Chough, Hae Kwan Park; , Kyung Jin Lee; , Hyoung Kyun Rha

Journal of Korean Society of Geriatric Neurosurgery 2009;5(1):61-66.
Published online June 30, 2009.

Hemodynamic Stability during Carotid Artery stenting Under General Anesthesia in Elderly Patients with a High Grade Carotid Artery Stenosis

Sang Hyo Kim , Chul Bum Cho , Won Il Joo , Chung Kee Chough, Hae Kwan Park , Kyung Jin Lee , Hyoung Kyun Rha

Department of Neurosurgery, Catholic Neuroscience Center, St. Mary\'s Hospital Catholic University, Korea

고령의 고도 경동맥 협착 환자에서 전신마취하에 시행한 경동맥 그물망 삽입술 시행시의 혈역학적 안정성

김상효ㆍ조철범ㆍ주원일ㆍ조정기ㆍ박해관ㆍ이경진ㆍ나형균

가톨릭대학교 의과대학 신경외과학교실, 가톨릭 뇌신경센터

Abstract

Objective
During carotid artery stenting (CAS) under local anesthesia, hemodynamic instabilities (hypotension, bradycardia etc.) have been reported to occur. Hemodynamic instability during CAS under local anesthesia, especially in elderly patients, may be a risk factor for complications. Thus, we evaluated the hemodynamic stability during CAS under general anesthesia in elderly patients with a high grade carotid artery stenosis.
Methods
A total of 15 patients CAS procedures were performed under general anesthesia using sevoflurane and nitrous oxide in oxygen in patients aged 65 years or older between November 2007 and February 2009. All CAS procedures were performed for high grade stenoses (>70% in NASCET criteria). Nine procedures were performed for symptomatic stenoses. Degree of systolic blood pressure change, hypotension, and bradycardia during CAS were assessed.
Results
The mean age of patients was 69±3.2 years old. The mean degrees of stenosis before and after CAS were 75.8±7.5% and 25.9±9.8%, respectively. Hypotension (SBP <80 mmHg) during the procedures did not occur in any of patients and transient bradycardia (HR <50 min) occurred in 1 (0.6%) during procedures. The mean systolic blood pressure change was 35±11.9 mmHg. No procedure related complication, such as stroke, was seen during and after CAS.
Conclusion
General anesthesia using sevoflurane and nitrous oxide in oxygen depressed baroreceptor reflex sensitivity, induced hemodynamic stability during CAS, and may decrease the rate of occurrence of complications in elderly patients with a high-grade carotid artery stenosis.

Key Words: Carotid artery stentingㆍHemodynamic stabilityㆍGeneral anesthesia