The nurse recovering a 65 year gentleman who underwent rt carotid endartectomy 2 hours ago calls you asking for a urgent review. The patient’s blood pressure is high 190/ 100 and he is complaining of a severe headache.
What is your management plan?
What are the Pre-Operative risks factors that can be identified in his history?
Can you illustrate your management algorithms?
1_ control bp acc to trust guide lines iv bb CBC
2 hx of hypertension hyperlipidemia
3 pain killers
Control bp
Check drains
Reassesment of headache
If needed CT brain
What is your management plan?
There should be local hospital guidelines for management of hypertension post CEA.
Anti hypertensive medication should be administered immediately oral or IV.
What are the Pre-Operative risks factors that can be identified in his history?
history of Hypertension, Dm , Hyperlipidemia , Cardiac history .
Can you illustrate your management algorithms?
if the headache is mild to moderate do Trans carotid Doppler and go for conservative management
if the headache is severe and or there is neurological deficit go for brain CT
if the brain ct shows ischemic infarction consider embolectomy, thrombectomy or aspiration
1_ control bp acc to trust guide lines iv bb CBC
2 hx of hypertension hyperlipidemia
3 pain killers
Control bp
Check drains
Reassesment of headache
If needed CT brain
management plan:
there should be local hospital guidelines for management of HTN post carotid intervention (ESVS Recommendation 98 class 1 level c). in this scenario I will prescribe B blocker, keep an eye on invasive blood pressure monitoring, and close follow up.
preoperative risk: female sex, recent major stroke, CAD, and a contralateral stenosis more than 70%
This patient has cerebral hyperperfusion syndrome.
Plan of management is:
1. Brain ct
2. Cerebral dehydrating measures like mannitol, diuretics, corticosteroids.
3. Stop anticoagulants
4. Strict blood pressure control
Q1. CT brain
TCD
ICU admission
Agressive blood pressure control
Stop antiplatelet and anticogulant
Good hydration
Q2. Long standing unctrolled, Bp old age, recent less than 3 montth CEA, DM, high grade Ipsilateral carotid stenosis, contralateral carotid occlusion, incomplete circle of willis,
Q3. Picture attached for algorithem
Thank you for your response
What is the value of stopping antiplatelets at this stage?
Is the patient usually on anticoagulants?
Can you clarify your Aggressive blood pressure control strategy?
Q1. To decrease risk of ICH and wound haematoma with high Bp and antiplatelte
Q2. No.
Q3. By IV betal blookers such labtetlol to decresae Bp gradually to less than 140/90 the goal would be to lower the mean arterial pressure by 20% to 25% within the first 1 to 2 hours with Blood pressure should be monitored continuously via an arterial line