• LA for CEA
  Link:www.frcamindmaps.org/mindmaps/misc/trials/trials.html
  
• Patient less likely to tolerate cross clamping if they have had a previous stroke
• Mean stump pressure of 50mmHg is accepted as sufficient to perfuse the hemisphere
• TCD, NIRS or EEG have been used
• LA techniques allow clinical assessment and is seen as the gold standard by some and may reduce shunt rate by 10%
• Further management
• Arm board
• IV heparin often given pre-clamping
• IA access
• No need to catheterise if LA
• Fluid usually ~1L
• Vasopressors or anti-hypertensives may be needed
• Consider HDU or prolonged recovery
• Post-op stroke requires further investigation
• Beware haematoma
• VTE prophylaxis often delayed for 1/7
• Regional anaesthesia
  Link:www.nysora.com/techniques/nerve-stimulator-and-surface-based-ra-techniques/upper-extremitya/3345-cervical-plexus-block.html?print
  
• Need to block C2/3/4 dermatomes
• Local infiltration of the sheath is necessary too and behind the angle of the jaw
• Deep cervical plexus block
• The nerves exit at their respective levels near the transverse processes and may be blocked at this level (deep) or at the level of their cutaneous branches (superficial)
• Can be done at all 3 levels or by single injection at C3/4
• Head turned away, the mastoid (C1) and transverse process of C6 (cricoid level) are identified and a line drawn between them
• Equidistant intervals ~1.5cm mark C2/3/4
• 22g needle advanced until paraesthesia, pop or transverse process is felt (1-2.5cm)
• 3ml of 0.5% bupivicaine at each level
• Superficial cervical plexus block
• Safer and easier
• Posterior border of SCM muscle
• 10ml 0.5% L-bupivicaine