BACKGROUND: Carotid endarterectomy is a very high risk operation, combined with high incidence of stroke and myocardial infarction. We experienced 36 cases of carotid endarterectomies during the last two years. We reviewed these cases with anesthetic management and neurologic monitoring. METHODS: All of the operations were performed under general anesthesia. 33 cases were monitored by EEG and SEP. We maintained cerebral perfusion during cross-clamping and shunt by normothermia, normocarbia and mild hypertension. RESULTS: 33% of the patients had severe coronary artery stenosis and 41% had severe contralateral carotid artery stenosis preoperatively. During the operation, 10 patients showed transient EEG changes without SEP change or neurologic sequele. The major postoperative complication was myocarial infarction in one patient. There were 3 cases of postoperative cerebral infarction in radiologic findings. One case occurred after myocardial infarction and the other two cases showed no clinical evidence of neurologic deficit. CONCLUSIONS: In anesthetic management of carotid endarterectomy patients, maintaining cerebral perfusion, preventing perioperative myocardial infarction are important and monitoring neurologic function with EEG and SEP should be considered to prevent neurologic deficits.