Time to Post-Anesthesia Neurological Evaluation With Three Different Anesthetic Techniques
Condition: Carotid Artery Stenosis
MeSH terms: Carotid Stenosis
Intervention: Remifentanil, Propofol, and Desflurane; Remifentanil, Dexmedetomidine, and Desflurane; Remifentanil and Desflurane
Intervention description: Remifentanil - titratable; initial starting dose 0.05 mcg/kg/min Propofol - titratable; initial starting dose 75 mcg/kg/min Desflurane 0.5 MAC; Remifentanil - titratable; initial starting dose 0.05 mcg/kg/min Dexmedetomidine - titratable; initial starting dose 0.5 mcg/kg/hr Desflurane 0.5 MAC; Remifentanil - titratable; initial starting dose 0.05 mcg/kg/min Desflurane - titratable
Intervention MeSH terms: Dexmedetomidine; Remifentanil; Propofol; Desflurane
Phase: Phase 4
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Enrollment: 21.0
Sex: All
Minimum age: 18 Years
Healthy volunteers: No

Summary:

      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.
    

Eligibility criteria:

        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