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

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.

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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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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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Low morbidity and mortality of carotid endarterectomy performed with regional anesthesia

Journal of Neurosurgery ◽

10.3171/jns.1988.69.4.0483 ◽

1988 ◽

Vol 69 (4) ◽

pp. 483-487 ◽

Cited By ~ 30

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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Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽

10.1024/0301-1526/a000601 ◽

2017 ◽

Vol 46 (2) ◽

pp. 116-120 ◽

Cited By ~ 4

Author(s):

Naz Ahmed ◽

Damian Kelleher ◽

Manmohan Madan ◽

Sarita Sochart ◽

George A. Antoniou

Keyword(s):

Ischaemic Stroke ◽

Carotid Endarterectomy ◽

Acute Ischaemic Stroke ◽

Intravenous Thrombolysis ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Wound Complications ◽

Cardiac Complications ◽

High Dependency ◽

Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

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Regional Cervical Plexus Blockage for Carotid Endarterectomy in Patients with Cardiovascular Risk Factors

The Heart Surgery Forum ◽

10.1532/hsf.1385 ◽

2015 ◽

Vol 18 (4) ◽

pp. 140 ◽

Cited By ~ 2

Author(s):

Mehmet Taşar ◽

Mehmet Kalender ◽

Okay Güven Karaca ◽

Ata Niyazi Ecevit ◽

Salih Salihi ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Carotid Endarterectomy ◽

Regional Anesthesia ◽

Carotid Artery Disease ◽

Risk Groups ◽

Cardiac Risk ◽

Cervical Plexus ◽

Cardiac Risk Factors ◽

Significant Difference

Background: Carotid artery disease is not rare in cardiac patients. Patients with cardiac risk factors and carotid stenosis are prone to neurological and cardiovascular complications. With cardiac risk factors, carotid endarterectomy operation becomes challenging. Regional anesthesia is an alternative option, so we aimed to investigate the operative results of carotid endarterectomy operations under regional anesthesia in patients with cardiac risk factors. Methods: We aimed to analyze and compare outcomes of carotid endarterectomy under regional anesthesia with cardiovascular risk groups retrospectively. Between 2006 and 2014, we applied 129 carotid endarterectomy ± patch plasty to 126 patients under combined cervical plexus block anesthesia. Patients were divided into three groups (high, moderate, low) according to their cardiovascular risks. Neurological and cardiovascular events after carotid endarterectomy were compared. Results: Cerebrovascular accident was seen in 7 patients (5.55%) but there was no significant difference between groups (P > .05). Mortality rate was 4.76% (n = 6); it was higher in the high risk group and was not statistically significant (P = .180). Four patients required revision for bleeding (3.17%). We did not observe any postoperative surgical infection. Conclusion: Carotid endarterectomy can be safely performed with regional cervical anesthesia in all cardiovascular risk groups. Comprehensive studies comparing general anesthesia and regional anesthesia are needed.

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Implantable neural interfaces

10.1093/oso/9780199674923.003.0050 ◽

2018 ◽

Author(s):

Stefano Vassanelli

Keyword(s):

Brain Function ◽

Large Scale ◽

Ionic Channels ◽

Patch Clamp Technique ◽

Advantages And Disadvantages ◽

Optogenetic Stimulation ◽

Physical Interfaces ◽

The Brain

Establishing direct communication with the brain through physical interfaces is a fundamental strategy to investigate brain function. Starting with the patch-clamp technique in the seventies, neuroscience has moved from detailed characterization of ionic channels to the analysis of single neurons and, more recently, microcircuits in brain neuronal networks. Development of new biohybrid probes with electrodes for recording and stimulating neurons in the living animal is a natural consequence of this trend. The recent introduction of optogenetic stimulation and advanced high-resolution large-scale electrical recording approaches demonstrates this need. Brain implants for real-time neurophysiology are also opening new avenues for neuroprosthetics to restore brain function after injury or in neurological disorders. This chapter provides an overview on existing and emergent neurophysiology technologies with particular focus on those intended to interface neuronal microcircuits in vivo. Chemical, electrical, and optogenetic-based interfaces are presented, with an analysis of advantages and disadvantages of the different technical approaches.

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Why ability point estimates can be pointless: a primer on using skill measures from large-scale assessments in secondary analyses

Measurement Instruments for the Social Sciences ◽

10.1186/s42409-020-00020-5 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Clemens M. Lechner ◽

Nivedita Bhaktha ◽

Katharina Groskurth ◽

Matthias Bluemke

Keyword(s):

Measurement Error ◽

Statistical Models ◽

Test Scores ◽

Large Scale ◽

Equation Modeling ◽

Model Parameters ◽

Advantages And Disadvantages ◽

Point Estimates ◽

Secondary Analyses ◽

Large Scale Assessments

AbstractMeasures of cognitive or socio-emotional skills from large-scale assessments surveys (LSAS) are often based on advanced statistical models and scoring techniques unfamiliar to applied researchers. Consequently, applied researchers working with data from LSAS may be uncertain about the assumptions and computational details of these statistical models and scoring techniques and about how to best incorporate the resulting skill measures in secondary analyses. The present paper is intended as a primer for applied researchers. After a brief introduction to the key properties of skill assessments, we give an overview over the three principal methods with which secondary analysts can incorporate skill measures from LSAS in their analyses: (1) as test scores (i.e., point estimates of individual ability), (2) through structural equation modeling (SEM), and (3) in the form of plausible values (PVs). We discuss the advantages and disadvantages of each method based on three criteria: fallibility (i.e., control for measurement error and unbiasedness), usability (i.e., ease of use in secondary analyses), and immutability (i.e., consistency of test scores, PVs, or measurement model parameters across different analyses and analysts). We show that although none of the methods are optimal under all criteria, methods that result in a single point estimate of each respondent’s ability (i.e., all types of “test scores”) are rarely optimal for research purposes. Instead, approaches that avoid or correct for measurement error—especially PV methodology—stand out as the method of choice. We conclude with practical recommendations for secondary analysts and data-producing organizations.

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SARS-CoV-2 vaccines strategies: a comprehensive review of phase 3 candidates

npj Vaccines ◽

10.1038/s41541-021-00292-w ◽

2021 ◽

Vol 6 (1) ◽

Cited By ~ 3

Author(s):

Nikolaos C. Kyriakidis ◽

Andrés López-Cortés ◽

Eduardo Vásconez González ◽

Alejandra Barreto Grimaldos ◽

Esteban Ortiz Prado

Keyword(s):

Neutralizing Antibodies ◽

Large Scale ◽

Vaccine Development ◽

Rna Virus ◽

Protein S ◽

Effective Vaccine ◽

Phase 3 ◽

Vaccine Candidates ◽

Advantages And Disadvantages ◽

The World

AbstractThe new SARS-CoV-2 virus is an RNA virus that belongs to the Coronaviridae family and causes COVID-19 disease. The newly sequenced virus appears to originate in China and rapidly spread throughout the world, becoming a pandemic that, until January 5th, 2021, has caused more than 1,866,000 deaths. Hence, laboratories worldwide are developing an effective vaccine against this disease, which will be essential to reduce morbidity and mortality. Currently, there more than 64 vaccine candidates, most of them aiming to induce neutralizing antibodies against the spike protein (S). These antibodies will prevent uptake through the human ACE-2 receptor, thereby limiting viral entrance. Different vaccine platforms are being used for vaccine development, each one presenting several advantages and disadvantages. Thus far, thirteen vaccine candidates are being tested in Phase 3 clinical trials; therefore, it is closer to receiving approval or authorization for large-scale immunizations.

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Large-Scale Linear RankSVM

Neural Computation ◽

10.1162/neco_a_00571 ◽

2014 ◽

Vol 26 (4) ◽

pp. 781-817 ◽

Cited By ~ 48

Author(s):

Ching-Pei Lee ◽

Chih-Jen Lin

Keyword(s):

Decision Trees ◽

Computational Efficiency ◽

Efficient Algorithm ◽

Large Scale ◽

Learning To Rank ◽

Gradient Boosting ◽

Baseline Model ◽

Nonlinear Methods ◽

Advantages And Disadvantages ◽

Linear Ranksvm

Linear rankSVM is one of the widely used methods for learning to rank. Although its performance may be inferior to nonlinear methods such as kernel rankSVM and gradient boosting decision trees, linear rankSVM is useful to quickly produce a baseline model. Furthermore, following its recent development for classification, linear rankSVM may give competitive performance for large and sparse data. A great deal of works have studied linear rankSVM. The focus is on the computational efficiency when the number of preference pairs is large. In this letter, we systematically study existing works, discuss their advantages and disadvantages, and propose an efficient algorithm. We discuss different implementation issues and extensions with detailed experiments. Finally, we develop a robust linear rankSVM tool for public use.

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