scholarly journals Carotid Endarterectomy with Local Anesthesia and LMA/General Anesthesia

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.

Carotid endarterectomy under local and/or regional anesthesia has less risk of myocardial infarction compared to general anesthesia: An analysis of national surgical quality improvement program database

Vascular ◽  
2014 ◽  
Vol 23 (2) ◽  
pp. 113-119 ◽  
Author(s):  
Elias Kfoury ◽  
Jonathan Dort ◽  
Amber Trickey ◽  
Moira Crosby ◽  
Jean Donovan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Quality Improvement ◽  
General Anesthesia ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Artery Bypass ◽  
Quality Improvement Program ◽  
Improvement Program ◽  
Surgical Quality ◽  
Postoperative Myocardial Infarction

Multiple studies have evaluated the effect of anesthesia type on carotid endarterectomy with inconsistent results. Our study compared 30-day postoperative myocardial infarction, stroke, and mortality between carotid endarterectomy under local or regional anesthesia and carotid endarterectomy under general anesthesia utilizing National Surgical Quality Improvement Program database. All patients listed in National Surgical Quality Improvement Program database that underwent carotid endarterectomy under general anesthesia and local or regional anesthesia from 2005 to 2011 were included with the exception of patients undergoing simultaneous carotid endarterectomy and coronary artery bypass grafting. The data revealed substantial differences between the two groups compared, and these were adjusted using multiple logistic regression. Postoperative myocardial infarction, stroke, and death at 30 days were compared between the two groups. A total of 42,265 carotid endarterectomy cases were included. A total of 37,502 (88.7%) were performed under general anesthesia and 4763 (11.3%) under local or regional anesthesia. Carotid endarterectomy under local or regional anesthesia had a significantly decreased risk of 30-day postoperative myocardial infarction when compared to carotid endarterectomy under general anesthesia (0.4% vs 0.86%, p = 0.012). No statistically significant differences were found in postoperative stroke or mortality. Carotid endarterectomy under local or regional anesthesia carries a decreased risk of postoperative myocardial infarction when compared to carotid endarterectomy under general anesthesia. Therefore, patients at risk of postoperative myocardial infarction undergoing carotid endarterectomy, consideration of local or regional anesthesia may reduce that risk.

scholarly journals Anesthesia for Cesarean Delivery and Learning Disabilities in a Population-based Birth Cohort

2009 ◽  
Vol 111 (2) ◽  
pp. 302-310 ◽  
Author(s):  
Juraj Sprung ◽  
Randall P. Flick ◽  
Robert T. Wilder ◽  
Slavica K. Katusic ◽  
Tasha L. Pike ◽  
...  
Keyword(s):  
Learning Disabilities ◽  
General Anesthesia ◽  
Cesarean Delivery ◽  
Birth Cohort ◽  
Regional Anesthesia ◽  
Population Based ◽  
Perinatal Exposure ◽  
Neurodevelopmental Outcomes ◽  
Anesthetic Drugs

Background Anesthetics administered to immature brains may cause histopathological changes and long-term behavioral abnormalities. The association between perinatal exposure to anesthetics during Cesarean delivery (CD) and development of learning disabilities (LD) was determined in a population-based birth cohort. Methods The educational and medical records of all children born to mothers residing in five townships of Olmsted County, Minnesota from 1976-1982 and remaining in the community at age 5 were reviewed to identify those with LDs. Cox proportional hazards regression was used to compare rates of LD between children delivered vaginally and via CD (with general or regional anesthesia). Results Of the 5,320 children in this cohort, 497 were delivered via CD (under general anesthesia n = 193, and regional anesthesia n = 304). The incidence of LD depended on mode of delivery (P = 0.050, adjusted for sex, birth weight, gestational age, exposure to anesthesia before age 4 yr, and maternal education). LD risk was similar in children delivered by vagina or CD with general anesthesia, but was reduced in children receiving CD with regional anesthesia (hazard ratio = 0.64, 95% confidence interval 0.44 to 0.92; P = 0.017 for comparison of CD under regional anesthesia compared to vaginal delivery). Conclusion Children exposed to general or regional anesthesia during CD are not more likely to develop LD compared to children delivered vaginally, suggesting that brief perinatal exposure to anesthetic drugs does not adversely affect long-term neurodevelopmental outcomes. The risk of LD may be lower in children delivered by CD whose mothers received regional anesthesia.

scholarly journals The Choice of the Type of Anesthesia for Carotid Endarterectomy (Review)

2018 ◽  
Vol 14 (6) ◽  
pp. 95-113
Author(s):  
Oleg V. Simonov ◽  
Igor N. Tyurin ◽  
Alexander D. Pryamikov ◽  
Alexey B. Mironkov
Keyword(s):  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Large Scale ◽  
Neurological Status ◽  
Anesthetic Technique ◽  
Cardiac Complications ◽  
Advantages And Disadvantages ◽  
Frequent Use ◽  
Carotid Artery Lesions ◽  
Combined Anesthesia

The article summarizes the international experience of using different types of anesthesia for the surgical treatment of carotid artery lesions. The anesthesiology support of surgery on the carotid basin includes general and combined anesthesia of various types. The regional anesthesia is a separate field in the carotid surgery. The paper presents the advantages and disadvantages of each anesthetic technique. The recent publications show the superiority of regional anesthesia in terms of its cost-effectiveness, less frequent use of temporary intraluminal shunt, the possibility to constant monitoring of patient’s neurological status throughout the operation, and lower incidence of neurologic and cardiac complications. Complications of the regional anesthesia and the methods of their correction are described in detail. There is still no consensus about the choice of the optimal type of anesthesia for carotid endarterectomy, hence further large-scale randomized trials are needed.

scholarly journals Long-Term Carotid Artery Disease Progression and Related Neurologic Events Following Carotid Endarterectomy

2014 ◽  
Vol 59 (2) ◽  
pp. 562-563
Author(s):  
Efthymios D. Avgerinos ◽  
Catherine Go ◽  
Jennifer Ling ◽  
Abdallah Naddaf ◽  
Amy L. Steinmetz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Disease Progression ◽  
Carotid Artery Disease ◽  
Artery Disease

scholarly journals Rehabilitation of cardiovascular pathology

2020 ◽  
Author(s):  
Centritto Enrico Maria ◽  
Colombo Antonio ◽  
Modugno Pietro
Keyword(s):  
General Anesthesia ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Speech Therapy ◽  
Point Of View ◽  
Evidence Based ◽  
Peripheral Oxygen Saturation ◽  
Cough Reflex ◽  
Operative Recovery ◽  
Respiratory Rehabilitation

It is interesting to evaluate the role of cardiovascular and respiratory rehabilitation in patients undergoing carotid endo-arterectomy by observing the differences between patients undergoing general anesthesia and those under local anesthesia, with the aim of decreasing the risk of de-veloping post-surgical complications, restore respiratory compliance and reduce user hospitali-zation times. The aim of the study was to verify the effectiveness of rehabilitation treatment in a homogeneous group of 20 patients with symptomatic and non-symptomatic stenosis and / or ≥ 70% undergo-ing carotid endarterectomy, 10 under general anesthesia and 10 in loco-regional anesthesia, through a cycle of respiratory rehabilitation according to the rehabilitation protocol of the user undergoing cardiovascular surgery (Evidence Based Physiotherapy and Evidence Based Speech Therapy). From the analysis of these two patients’ groups, conclusions were drawn regarding the validity of physiotherapy treatment in the post-operative recovery of the patient undergoing carotid endarterectomy. Although the literature apparently showed no statistically significant differences between the two types of anesthesia, in our small study we recorded a difference between the two types of respiratory anesthesia. In Loco-regional Anesthesia, we found a stability in the lev-els of peripheral oxygen saturation at discharge compared to pre-operative. In the group of pa-tients undergoing surgery by general anesthesia, peripheral saturimetry values worsened be-tween pre-operative and discharge. The loco-regional anesthesia would seem to be more advantageous from a respiratory point of view than the general anesthesia in the general recovery of the patient. Also from a clinical point of view, in the patients of the loco-regional anesthesia group there was a lower perception of dyspnea, the absence of exacerbation of the cough reflex, a decrease in the difficulty in ex-pectorating and a lesser presence of secretions in the airway.

Low morbidity and mortality of carotid endarterectomy performed with regional anesthesia

1988 ◽  
Vol 69 (4) ◽  
pp. 483-487 ◽  
Author(s):  
K. Stuart Lee ◽  
Courtland H. Davis ◽  
Joe M. McWhorter
Keyword(s):  
Myocardial Infarction ◽  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Surgical Techniques ◽  
Morbidity And Mortality ◽  
Anesthetic Technique ◽  
Cerebral Function ◽  
Content Type ◽  
Postoperative Hypertension ◽  
Low Incidence

✓ Various anesthetic and surgical techniques have been recommended with or without cerebral function monitoring in attempts to reduce the risk of carotid endarterectomy, but there is no consensus as to the ideal method for performing this procedure. General anesthesia is now the most common anesthetic technique used, but of 337 carotid endarterectomies performed by the authors' service from 1981 through 1985, 305 (91%) were conducted with regional anesthesia. This paper presents the morbidity and mortality rates for those patients. There were two perioperative transient ischemic attacks (0.66%), two perioperative strokes (0.66%), and two perioperative deaths (0.66%). No patient in the series suffered a myocardial infarction within 30 days after endarterectomy. This series demonstrates that carotid endarterectomy can be performed with good results using regional anesthesia, which facilitates intraoperative cerebral function monitoring. Regional anesthesia is associated with a very low incidence of postoperative hypertension and perioperative myocardial infarction.

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