Keeping Yourself Safe at Work

Patients are at risk for many postoperative complications following carotid endarterectomy. These complications include neck hematoma with potential airway compromise, nerve injury (e.g., transient or permanent recurrent laryngeal nerve damage), hypertension or hypotension (due to carotid sinus dysfunction), and hyperperfusion syndrome. Additionally, patients undergoing carotid endarterectomy are at increased risk for postoperative myocardial infarction and stroke. Carotid body denervation is another risk of carotid endarterectomy. Carotid bodies are peripheral chemoreceptors located at the bifurcation of the common carotid artery. When PaO2 drops to 55-60 mmHg, the carotid bodies send an impulse to the brainstem to increase ventilation (i.e., increase respiratory rate, tidal volume). Surgical denervation of the carotid body may cause a decrease in the ventilatory response to hypoxemia. Carotid body denervation following unilateral carotid endarterectomy generally results in decreased responsiveness to mild hypoxia; however, bilateral carotid endarterectomy carries the theoretical risk of bilateral carotid body dysfunction, which could result in significant impairment of a patient’s hypoxic drive. Patients would then be dependent on central chemoreceptors to increase ventilation in response to hypoxia. Patients undergoing bilateral carotid endarterectomy also incur an increased risk of bilateral recurrent laryngeal nerve damage, potentially resulting in bilateral vocal cord paralysis and airway obstruction.