Time to Post-Anesthesia Neurological Evaluation With Three Different Anesthetic Techniques
Time to Post-Anesthesia Neurological Evaluation With Three Different Anesthetic Techniques
The objective of this pilot study is to analyze the differences in time to first
 postoperative neurological examination (cranial nerve XII - tongue movement, movement of
 extremities) and intraoperative hemodynamic stability with three different general anesthetic
 techniques that are used for carotid endarterectomy. Carotid endarterectomy surgery removes
 the plaque and stenosis but has a 1-3% risk of periprocedural stroke or death. The ability to
 detect neurological abnormalities early after surgery is vital in this patient population to
 facilitate timely additional diagnostics or interventions if a potential stroke is detected.
 Anesthetic techniques that facilitate an earlier reliable neurological exam will thus greatly
 benefit this surgical patient population. The primary objective of this pilot study is to
 determine the time difference from end of surgery to first neurologic exam between three
 commonly used anesthetic methods for carotid endareterectomy.
Inclusion Criteria:

 1. 18 years of age and older

 2. Having carotid endarterectomy surgery

 3. Able to undergo a preoperative neurological exam

 Exclusion Criteria:

 1. Pregnant patients

 2. Prisoners

 3. Patients with dementia or reduced mental status acute or chronic

 4. Known brain tumor or head trauma

 5. Known severe, uncorrected coronary artery disease (CAD)

 6. Ejection fraction (EF) less than 15%

 7. Patients with intraaortic ballon pump (IABP) or other mechanical circulatory assist
 device

 8. Patients with severe chronic obstructive pulmonary disease (COPD)

 9. Combined surgical procedures (CABG and CAD)

 10. Patients with uncontrolled or severe anxiety requiring benzodiazepine administration

 11. Patients with history of difficult airway

 12. Sedation other than propofol, dexmedetomidine or volatile anesthetic agent (VAA) is
 needed for patient (i.e. ketamine in patients with history of neuropathic pain)

 13. Intubated or unconscious patients

 14. Patients on methadone or fentanyl patch

 15. Patients with known unusual or extreme anesthetic requirements

 16. Patients who would require an unusual amount of narcotic to control pain

 17. Patients having endarterectomy wherein surgeon requests local-regional anesthesia only

 18. Patients with known history of prolonged emergence from anesthesia

 19. Morbidly obese patients (BMI >40)

 20. Patients with scalp or forehead defects that prohibit application of BIS monitor strip