Perioperative morbidity and mortality of carotid artery surgery under loco-regional anaesthesia

VASA ◽  
2005 ◽  
Vol 34 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Assadian ◽  
Senekowitsch ◽  
Assadian ◽  
Ptakovsky ◽  
Hagmüller
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Regional Anaesthesia ◽  
Carotid Arteries ◽  
Morbidity And Mortality ◽  
Single Centre ◽  
Carotid Artery Surgery ◽  
Fontaine Stage

Background: Loco-regional anaesthesia for carotid artery surgery has many advantages over general anaesthesia. It may be associated with a reduction in neurological, and equally important, non-neurological morbidity and mortality. However, sufficiently powered randomised controlled trials comparing general anaesthesia with local anaesthesia for carotid artery surgery are not yet published. Herein, we present our single centre experience of carotid endarterectomy under local anaesthesia and their respective procedure-related morbidity and mortality rates. Patients and methods: From January 1996 to December 2002, 1271 patients were operated on their carotid arteries. Of these, 1210 (95%) patients and 1355 carotid arteries were operated on in loco-regional anaesthesia and included in a prospective recording. The patients age ranged from 47 to 100 years (mean 70.5 years), 711 patients were male, 499 female. 496 patients (41%) were asymptomatic (Fontaine stage I), 460 have had a transient neurological deficit (TIA) prior to admission (Fontaine stage II) and 254 patients have had a stroke (Fontaine stage IV). Results: The combined stroke rate was 2.2% (n = 30). The overall 30 day mortality was 0.2% (n = 3). The rate of haematoma indicating revision was 3% (n = 40). The revision in all cases was within 12 hours of surgery. No patient developed respiratory insufficiency after surgery. However, of the 40 patients with revision for haematoma, 4 (10%) needed prolonged respiratory assistance and one patient ultimately died of respiratory insufficiency and stroke. No cardiac mortality was observed. The over all rate of myocardial infarction observed postoperatively was 1.4% (n = 19), of which 1.1% (n = 15) were non q-wave infarcts. The combined shunting-rate for all stages was 18.6% (n = 252). Conclusion: Morbidity and mortality of carotid endarterectomy in loco-regional anaesthesia is comparable to recently published single-centre results. Patients with severe COPD, usually unsuitable candidates for general anaesthesia, can also be treated safely.

Carotid artery surgery. Local versus general anaesthesia as related to sympathetic activity and cardiovascular effects

1990 ◽  
Vol 4 (3) ◽  
pp. 265-270 ◽  
Author(s):  
Rabbe Takolander ◽  
David Bergqvist ◽  
U. Lennart Hulthén ◽  
Arne Johansson ◽  
Per L. Katzman
Keyword(s):  
Carotid Artery ◽  
General Anaesthesia ◽  
Sympathetic Activity ◽  
Cardiovascular Effects ◽  
Carotid Artery Surgery

HYPOTENSION DURING SPINAL ANAESTHESIA FOR CAESAREAN SECTION: IMPLICATIONS, DETECTION PREVENTION AND TREATMENT

2006 ◽  
Vol 17 (2) ◽  
pp. 157-183 ◽  
Author(s):  
KIM S KHAW ◽  
WARWICK D NGAN KEE ◽  
SHARA WY LEE
Keyword(s):  
Caesarean Section ◽  
General Anaesthesia ◽  
Spinal Anaesthesia ◽  
Regional Anaesthesia ◽  
Maternal Morbidity ◽  
Morbidity And Mortality ◽  
Maternal Deaths ◽  
Maternal Morbidity And Mortality ◽  
Prevention And Treatment

Regional anaesthesia is preferred by most anaesthetists for the majority of caesarean sections. The major advantage of regional anaesthesia is the avoidance of maternal morbidity and mortality associated with general anaesthesia. The importance of this can be seen in the most recent Report of Confidential Enquires into Maternal Deaths in which it was reported that of the direct maternal deaths attributed to anaesthesia, all six were associated with difficulties during general anaesthesia. Although a number of regional anaesthesia techniques are available, spinal anaesthesia is particularly popular because it is fast, easy to perform and provides excellent intraoperative analgesia.

scholarly journals General anaesthesia versus cervical block and perioperative complications in carotid artery surgery

1997 ◽  
Vol 13 (1) ◽  
pp. 37-42 ◽  
Author(s):  
P. Fiorani ◽  
E. Sbarigia ◽  
F. Speziale ◽  
M. Antonini ◽  
B. Fiorani ◽  
...  
Keyword(s):  
Carotid Artery ◽  
General Anaesthesia ◽  
Perioperative Complications ◽  
Carotid Artery Surgery

Thirty-day morbidity and mortality rates for carotid artery intervention by surgeons who perform both carotid endarterectomy and carotid artery angioplasty and stent placement

2007 ◽  
Vol 106 (2) ◽  
pp. 217-221 ◽  
Author(s):  
Robert D. Ecker ◽  
Tsz Lau ◽  
Elad I. Levy ◽  
L. Nelson Hopkins
Keyword(s):  
High Risk ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Carotid Revascularization ◽  
Symptomatic Carotid ◽  
Risk Patients ◽  
Related Group ◽  
The University

Object There is no known standard 30-day morbidity and mortality rate for high-risk patients undergoing carotid artery (CA) angioplasty and stent (CAS) placement. The high-risk registries and the Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy, Carotid Revascularization using Endarterectomy or Stenting Systems, and European Long-term Carotid Artery Stenting trials report different rates of morbidity and mortality, and each high-risk cohort has a different risk profile. The applicability of carotid endarterectomy (CEA) results from North American Symptomatic Carotid Endarterectomy Trial/Asymptomatic Carotid Atherosclerosis Study (NASCET/ACAS) remains uncertain, as most clinical CAS placement series reported to date typically included patients who would not have qualified for those studies. At the University at Buffalo, the same neurosurgeons perform triage in patients with CA disease and perform both CEA and CAS insertion. The authors review morbidity and mortality rates in this practice model. Methods Diagnosis-related group codes were used to search the authors’ practice database for patients who had undergone a completed CA intervention solely for the indication of atherosclerotic disease. One hundred twenty patients (129 vessels) treated with CAS surgery and 95 patients (100 vessels) treated with CEA met these criteria. In the CAS placement group, 78% of the patients would not have met NASCET/ACAS inclusion criteria. Demographic and clinical data for both groups were recorded on a spreadsheet for analysis. At 30 days, one patient in the CEA group and two in the CAS group had died. Stroke occurred in one patient in the CAS group and none in the CEA group. Myocardial infarction (MI) occurred in one patient who underwent CAS surgery compared with three undergoing CEA. Composite incidence of stroke/death/MI was 3.3% in the CAS group and 3.2% in the CEA group. Conclusions In a practice in which surgeons perform both CEA and CAS surgery, the event rates for the CAS surgery equivalent to NASCET and ACAS rates for CEA can be achieved, even in high-risk NASCET/ACAS-ineligible patients in 78% of the CAS cases.

scholarly journals Techniques in carotid artery surgery

2008 ◽  
Vol 24 (2) ◽  
pp. E18 ◽  
Author(s):  
Jonathan Andrew Curtis ◽  
Kaj Johansen
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Stroke Unit ◽  
Primary Repair ◽  
Complete Removal ◽  
Major Objective ◽  
Carotid Artery Surgery ◽  
Eversion Endarterectomy

✓The major objective in carotid endarterectomy is to achieve safe and complete removal of intimal plaque and provide lasting, nonstenotic closure. Controversy exists as to which technical variation best achieves this. In this paper, the authors review the operative nuances and outcomes with conventional and eversion endarterectomy, with a focus on the latter. The views expressed reflect specific neurosurgical and vascular perspectives in the context of a multi-disciplinary stroke unit, where carotid stenosis is managed with all available open and endovascular means. The neurosurgical approach was almost entirely conventional endarterectomy with primary repair, while the vascular surgeons used the eversion method with few exceptions.

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