The perioperative anesthetic management of carotid body tumor resection includes a comprehensive preoperative airway assessment, optimization of patient comorbidities, and identification of symptoms pointing to secreting tumors. The goals of intraoperative hemodynamic management are to maintain normal baseline hemodynamics, avoiding extreme swings in blood pressure and heart rate. Whether regional or general anesthesia is used, the goals of perioperative management are to preserve stable hemodynamics and maintain end-organ perfusion, to prepare for resuscitation of acute major blood loss, to utilize monitoring modalities to identify, avoid, and manage cerebral ischemia, and to provide a smooth controlled emergence. Internal carotid artery clamping, reconstruction or sacrifice may be required for large grade III tumors or when the internal carotid artery is inadvertently injured. In the postoperative period, complications should be anticipated, diagnosed, and promptly managed. Patients undergoing bilateral carotid tumor surgery should be continuously monitored in an intensive care environment postoperatively.

This chapter discusses the utility of single-photon emission computed tomography (SPECT) in the evaluation of carotid disease and interventions. A prospective study demonstrated that reduced regional cerebrovascular reactivity (rCVR) to acetazolamide determined quantitatively using 133Xe SPECT is significantly associated with an increased risk of stroke recurrence in patients with symptomatic occlusion of the middle cerebral artery (MCA) or internal carotid artery. Post-operative hyperperfusion is observed only in patients with reduced preoperative cerebrovascular reactivity to acetazolamide. Preoperative assessment of cerebral blood flow (CBF) with acetazolamide challenge using SPECT can identify patients at risk for postcarotid endarterectomy hyperperfusion. A SPECT study performed between the first and third post-operative day could be advocated for the timely and reliable identification of patients at risk for hyperperfusion syndrome. CBF measurements can determine appropriate withdrawal of blood pressure control in patients with ischemic events related to other atherosclerotic steno-occlusive lesions.