The influence of anesthetic technique on perioperative complications after carotid endarterectomy

Abstract It has been shown that carotid endarterectomy reduces the incidence of stroke in patients with symptomatic extracranial occlusive vascular disease in the absence of major perioperative complications such as stroke or death. We present a retrospective study of 106 carotid endarterectomies performed under local anesthesia in 100 patients in whom transient ischemic attack (TIA) or minor stroke had occurred. Nonfatal stroke occurred in 2%, and TIA occurred in 1%. There was no perioperative mortality. Our study suggests that, under local anesthesia, even high risk patients can be operated safely and the majority of carotid endarterectomies can be performed without the use of an indwelling shunt. Meticulous surgical technique is of great importance for achieving low perioperative complications.

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Carotid Endarterectomy with Local Anesthesia and LMA/General Anesthesia

ScienceOpen Research ◽

10.14293/s2199-1006.1.sor-med.atxb4f.v1 ◽

2014 ◽

Author(s):

Hani Annabi ◽

Charles Fleischer ◽

Robert Taylor ◽

Steven Gruendling ◽

joe pergolizzi ◽

...

Keyword(s):

General Anesthesia ◽

Carotid Endarterectomy ◽

Regional Anesthesia ◽

Anesthetic Technique ◽

Hybrid Technique ◽

Comorbid Conditions ◽

Neurological Assessment ◽

Left Neck ◽

Artery Disease

There is no clear consensus as to the appropriate anesthetic technique for patients undergoing a carotid endarterectomy. Such patients may have comorbid conditions, such as coronary artery disease, hyperlipidemia, and others. The two main anesthetic approaches are general anesthesia, including an endotracheal tube, with neurological monitoring and regional anesthesia that allows for an awake patient to be assessed neurologically. The objective of our study was to evaluate a novel anesthetic technique that combined general anesthesia with a laryngeal mask airway (LMA) plus regional anesthesia in the form of bupivacaine injected into the surgical site. Anesthesia was maintained with desflurane 4%, so the patient emerged rapidly for neurological assessment at the conclusion of surgery. We report on a case of a 55-year-old patient who underwent a successful carotid endarterectomy using this hybrid technique of general anesthesia with LMA plus regional anesthesia. This technique was safe and effective and the patient experienced no complications other than a hematoma on the left neck that was likely the result of long-term use of aspirin and Plavix. While further study is warranted, this hybrid technique of general anesthesia with LMA plus regional anesthesia holds promise for carotid endarterectomy patients.

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Carotid endarterectomy: factors influencing perioperative complications

Journal of Neurology ◽

10.1007/bf00314196 ◽

1987 ◽

Vol 235 (1) ◽

pp. 39-41 ◽

Cited By ~ 1

Author(s):

H. Br�ckmann ◽

G. J. Zoppo ◽

A. Ferbert ◽

P. Bardos ◽

H. Zeumer

Keyword(s):

Carotid Endarterectomy ◽

Perioperative Complications ◽

Factors Influencing

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Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1688692 ◽

2019 ◽

Vol 80 (05) ◽

pp. 341-344

Author(s):

Jan Mracek ◽

Jakub Kletecka ◽

Irena Holeckova ◽

Jiri Dostal ◽

Jolana Mrackova ◽

...

Keyword(s):

Patient Satisfaction ◽

Carotid Endarterectomy ◽

Local Anesthesia ◽

Postoperative Nausea And Vomiting ◽

Anesthetic Technique ◽

Anesthetic Techniques ◽

Advantages And Disadvantages ◽

Future Preference ◽

Intraoperative Pain ◽

Optimal Approach

Background and Study Aims Both general and local anesthesia are used in our department for carotid endarterectomy (CEA). The decision as to which anesthetic technique to use during surgery is made individually. The aim of our study was to evaluate patient satisfaction and preference with the anesthesia type used. Material and Methods The satisfaction of a group of 205 patients with regard to anesthesia used and their future preferences were evaluated prospectively through a questionnaire. The reasons for dissatisfaction were assessed. Results CEA was performed under general anesthesia (GA) in 159 cases (77.6%) and under local anesthesia (LA) in 46 cases (22.4%). In the GA group, 148 patients (93.1%) were satisfied; 30 patients (65.2%) in the LA group were satisfied (p < 0.0001). The reason for dissatisfaction with GA were postoperative nausea and vomiting (7 patients), postoperative psychological alteration (3), and fear of GA (1). The reasons for dissatisfaction with LA were intraoperative pain (9 patients), intraoperative discomfort and stress (5), and intraoperative breathing problems (2). Of the GA group, 154 (96.9%) patients would prefer GA again, and of the LA group, 28 (60.9%) patients would prefer LA if operated on again (p < 0.0001). Overall, 172 patients (83.9%) would prefer GA in the future, and 33 patients (16.1%) would prefer LA. Conclusion Overall patient satisfaction with CEA performed under both GA and LA is high. Nevertheless, in the GA group, patient satisfaction and future preference were significantly higher. Both GA and LA have advantages and disadvantages for CEA. An optimal approach is to make use of both anesthetic techniques based on their individual indications and patient preference.

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