Cardiovascular

As stated earlier, in patients who have not already undergone carotid surgery, the barorecep-tors are present in the carotid bulb. During stretching of the stenosis, the baroreceptors can be activated, causing bradycardia. In some patients, this response is overly exaggerated, causing asystole. Usually, when the stimulus is removed, the heart rate responds, but not always. Again, these patients have many comorbidities, including cardiac disease. Patients who have prolonged bradycardia or asystole will require close monitoring to observe and treat any further stress on the heart.

Additionally, during the procedure, all of the lines infuse heparinized saline. Depending on the length of the procedure and the rate of administration, patients could receive >3 L of fluids. In younger patients, this might be identified as only a slight dilution of the hematocrit (hematocrit reduction of 3-6% is commonly seen in this scenario). However, in older patients, excess fluid can critically raise the cardiac filling pressures, resulting in pulmonary edema and frank cardiac failure.

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