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Patients with atherosclerotic carotid disease have a high incidence of concomitant coronary artery disease. This chapter presents a case study of a 59-year-old male presented for a right carotid endarterectomy (CEA) under regional anesthesia. A cardiac catheterization was followed by percutaneous coronary intervention with two bare metal stents to the left anterior descending and obtuse marginal vessels. The patient was instructed to hold his clopidogrel 5 days prior to his scheduled carotid surgery and to continue his aspirin perioperatively. After a stable intraoperative course, the patient was transferred to the recovery room in a stable condition. Patients with S-T segment elevation myocardial infarction (STEMI) of sufficient size have a reduction in left ventricle (LV) function resulting in a reduced stroke volume, reduced systemic blood pressure, and a consequent reduction in coronary perfusion pressure. Surgical patients with postoperative STEMI are poor candidates for fibrinolytic therapy.
Deep brain stimulation surgery for Parkinson's disease requires a systematic approach to preoperative assessment. The success of deep brain stimulation (DBS) surgery depends on proper patient selection, proper placement of the DBS electrode in the intended nucleus and proper programming. In view of this, the preoperative evaluation of the DBS patient assumes added importance. This chapter presents a case study of a 65-year-old male who was to be evaluated for DBS surgery. An awake intubation was performed and intraoperative electrophysiologic monitoring was employed during the surgery. This case highlights the following important preoperative evaluation issues in DBS patients: general surgical patient evaluation, disease-specific evaluation, neuropsychological evaluation, evaluation of associated medical conditions and airway evaluation. The neuropsychological assessment should include assessment of cognition, neuropsychiatric symptoms, social support, and goals for surgery. Understanding the medical and neuropsychological considerations of Parkinson's disease is essential for proper perioperative care.