SELECTIVE USE OF THE INTENSIVE-CARE UNIT FOLLOWING CAROTID ENDARTERECTOMY

The purpose of this study was to develop criteria by which selected pa tients can be observed solely on the ward following carotid endarterec tomy (CEA). One hundred consecutive CEA patients were retrospectively reviewed. Preoperative medical conditions were identified, and the pos tanesthesia recovery room course was reviewed in an attempt to predict the need for intensive care unit (ICU) level care. Forty-four of our 100 patients developed perioperative complications or conditions that required some intervention. Conditions included hypertension in 23, hy potension in nine, arrhythmias in six, and myocardial ischemia in two. Complications included nonfatal cerebrovascular accident (CVA) in one , fatal CVA in one, and postoperative bleeding in two. Sixteen patient s required ICU level intervention (hypertension in five, hypotension i n five, arrhythmias in two, nonfatal CVA in one, fatal CVA in one, and postoperative bleeding in two. Fifteen of the 16 were identified in t he recovery room. Fifty-three patients had a medical history of signif icant hypertension (42), cardiac disease (27), and/or recent CVA (seve n). Thirty-six (68%) of these patients required perioperative interven tion in some form; 12 (23%) required ICU level therapy. Eight of 47 (1 7%) patients without a significant medical history required interventi on; only four (9%) required ICU level care. All eight patients were id entified in recovery. Only 16 of 100 CEA patients required ICU level c are. Fifteen of 16 were identified in recovery. Certain patients ident ified in the recovery room can be followed safely in a less intense an d costly setting.