• Table of Contents
• Anesthetic Management of Aneurysms

 XX. AV Malformations

XXI. Ischemic Cerebrovascular Disease

       A. Hypertension is a lot worse than hypotension.
          Remember that blood pressure swings are to be
          expected when the carotid clamp is taken off and
          the carotid body is exposed to pressures it may
          have seen in the past. Don't be too aggressive
          about treating hypotension - it can change quickly
          into severe hypertension.

       B. Use a narcotic technique and low dose isoflurane,
          then control B/P swings with phenylepherine and
          nitroprusside.  Aim for a mean B/P of 90-100. PaCO2
          should be about 40.

       C. Surgeon may be encouraged to inject the carotid
          sinus with local anesthetic to reduce B/P swings.