Avoid excessive blankets over the patient, as he or she may become hot and uncomfortable under the drapes and operating room lights. Avoid excessive sedation as this may confuse the neurologic assessment during the cross clamp period. Pressure points are well padded to minimize positional discomforts. Intravenous fluids are restricted to avoid bladder distention. The patient's head position is secured with a two inch strap of tape.
Vascular access is secured in the arm opposite to the surgical site.
With this arrangement the surgeon has excellent surgical exposure, and the patient does not feel claustrophobic due to the drapes laying in close proximity to his or her face. Ensure that local infiltration at the carotid bulb is done before surgical manipulation as nausea bradycardia and hypotension may occur when the carotid sinus is manipulated. Establish verbal communication and monitor cognitive and motor function during the period in which arterial flow is interrupted by the cross clamp. The hand opposite the side of the operative field can be assessed for weakness during the cross clamp period by holding the patient's hand and having them give you a firm grip on command. Alternatively, a 'rubber ducky' can be given to the patient to squeeze on command to assess both motor and cognitive function.