Pre-Op:  1. TCAR: MAC w/ minimal sedation, Deep Cervical Block, Arterial line, pre-treat w/ glycopyrrolate (consider IM to increase duration of action). Regular Carotid: general, art line, consider 2 IV’s

2. Open Abdominal Vasular Bypass Procedures or AAA: Surgeon prefers Thoracic Epidurals placed preop, postop epidural infusion, will require care as far as postop anticoagulants

Anesthesia:  TCAR: MAC case, minimal sedation, patient may need to take verbal commands during. Heparin AFTER cut down but BEFORE arterial puncture. ACT target >=250sec. STRICT BP & HEART RATE CONTROL. Keep systolic BP 140-160mmHg during procedure. For “index procedure” where they reverse flow, MUST AVOID HYPOTENSION in order to have adequate reverse flow. Also MUST KEEP HR >70. Reverse flow= difference between arterial and venous BP. Have glycopyrrolate, and atropine ready as well as pressors in sticks and drips. Keep head immobile during procedure. Consider general if patient unable to tolerate sedation or position. Keep head of bed clear of tubes and wires for angiogram.

Post-Op:  Postop Epidurals for Open Abdominal Bypass Procedures or AAA