Thrombendarterectomy (Carotid)

Last updated: February 9, 2026

Access

PIV x2 large. Arterial line (pre to ensure BP robust throughout induction)

Airway

Oral ETT.

Induction

Standard (lidocaine/propofol +/- fentanyl)

Maintenance

TIVA (propofol/remifentanil/Nicard/Phenylephrine) for neuromonitoring (SSEP, EEG. Technically no motors, so a small amount of gas and/or paralytic can be used if desired)

Or could do MAC?!?
Emergence: Awake
Antibiotics: Cefazolin

Position: 0\

Notes

Consider having blood in room depending on extent of procedure, starting hgb.

Have heparin ready, ACT every 30 min
Once clamp on → discuss with surgeon regarding MAP goals, usually MAP > 100 to ensure appropriate perfusion to brain