Question

Mr. B. is a 72-year-old man who underwent right-sided carotid endarterectomy; he returns to the ICU following 2 hours of surgery. He has a history of high blood pressure, cholesterol, and insulin-controlled diabetes for 5 years, and he smoked for 20 years but quit within the last year. His vital signs on arrival include a blood pressure of 162/85, heart rate of 99 beats/min, temperature of 96.6°F (35.9°C), and respiratory rate of 28 breaths/min.

1. What interventions will you provide to prevent complications in this patient?

2. What assessment findings would indicate that cranial nerve damage had occurred?

3. What assessment findings would you notify the surgical team providers about?

Answer 1

1) Blood pressure should be carefully monitored after carotid endarterectomy, and elevated blood pressure should be aggressively treated, particularly in those with early symptoms of cerebral hyperperfusion syndrome (Grade C recommendation)

2) Anatomically, the cranial nerves travel through distinct locations in the brain, and because of this assessing them can sometimes give us early and detailed information about brain injury

3) This patient should be restarted on statin therapy for primary prevention of stroke and myocardial infarction. The patient has type 2 diabetes mellitus and coronary artery disease, and patients with these disorders benefit from high-intensity statin therapy to reduce the risk of atherosclerotic cardiovascular disease, including myocardial infarction and stroke. So surgical team should be aware of this.