[Anesthetic management for carotid and coronary artery surgery--concomitant versus two stage operation].

We reviewed the anesthetic management of 16 patients with concomitant severe coronary and carotid artery diseases. Eight patients underwent concomitant operations of coronary artery bypass graft and carotid endarterectomy, while the other 8 patients underwent two stage operation. Candidates for concomitant operations had unstable angina or serious coronary disease such as three vessel disease or severe stenosis of LMT. In comparison, most of patients undergoing two stage operation had symptomatic or occlusive carotid disease. In all cases, anesthesia was maintained with fentanyl and midazolam and the perfusion pressure during cardiopulmonary bypass was maintained above 70 mmHg. Some patients received thiopental or propofol for brain protection. The concomitant operations required much more transfusion and longer operation time than two stage operation. In addition, several cases of the concomitant operation needed intra-aortic balloon pumping or high dose of catecholamines. Indications for concomitant operation or two stage operation have to be determined through discussion among anesthesiologist, neurovascular as well as cardiovascular surgeons.