Bilateral carotid endarterectomy: Physiology


According to Miller, “bilateral recurrent laryngeal nerve injury and resultant bilateral vocal cord paralysis can result in life-threatening upper airway obstruction. This situation must be anticipated in patients who have previously undergone contralateral carotid endarterectomy or neck surgery… Bilateral carotid endarterectomy is associated with loss of the normal ventilatory and arterial pressure responses to acute hypoxia and an increased resting partial pressure of arterial carbon dioxide. In this situation, the central chemoreceptors are the primary sensors for maintaining ventilation, and serious respiratory depression may result from opioid administration”

Bilateral Carotid Endarterectomy: Risks

Bilateral recurrent nerve injury (complete upper airway obstruction)

Loss of normal response to hypoxia and hypercarbia (exquisite opioid sensitivity)

Loss of normal blood pressure responsiveness



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