Treatment modality | Comment |
---|---|
Blood pressure control | Strict control of blood pressure is recommended Lower blood pressure even in normotensive patients There are no definite guidelines about blood pressure parameters and management should be individualized Avoid medications which have vasodilatory effect such as calcium channel blockers Labetalol and clonidine are better options to treat elevated blood pressure in these patients |
Timing of carotid surgery | Carotid endarterectomy or stenting should be done within 2Â weeks of transient ischemic attack or stroke Patient is at risk of cerebral hyperperfusion syndrome if they underwent contralateral carotid endarterectomy in past 3Â months |
Type of anesthetic | High doses of volatile halogenated hydrocarbon anesthetics may lead to cerebral hyperperfusion syndrome Isoflurane is safer to use in these patients but can cause complications at higher doses Nitrous oxide is also safe but should not be used with isoflurane Propofol normalizes cerebral blood flow and is a safe option |
Use of anti-epileptic medications | Prophylactic use of an anti-epileptic drug is not recommended If patient has lateralized epileptiform discharges or a clinically manifest seizure spell, an anti-epileptic drug may be administered |
Use of hypertonic saline and mannitol | The evidence about the use of hypertonic saline and mannitol is not strong but may be administered if the patient has cerebral edema Corticosteroids and barbiturates are not indicated in most cases Hyperventilation and sedation may be administered if the patient has cerebral edema |