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.

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.

Cerebral hyperperfusion following carotid endarterectomy

1987 ◽  
Vol 66 (6) ◽  
pp. 824-829 ◽  
Author(s):  
Torben Schroeder ◽  
Henrik Sillesen ◽  
Ole Sørensen ◽  
Hans Christian Engell
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Pressure Ratio ◽  
Ipsilateral Hemisphere ◽  
Content Type ◽  
High Pressure Ratio ◽  
Cerebral Hyperperfusion ◽  
Postoperative Hypertension ◽  
Serial Measurements ◽  
Fine Print

✓ Serial measurements of cerebral blood flow (CBF) were performed in 56 patients before and one to four times after uncomplicated carotid endarterectomy. The findings were related to the ratio between internal carotid artery (ICA) and common carotid artery (CCA) mean pressures. Within the 1st postoperative day CBF increased by a median of 37% in the ipsilateral and 33% in the contralateral hemisphere. Later recordings showed a gradual return of CBF toward the preoperative level. Sixteen patients with an ICA/CCA pressure ratio below 0.7 showed a significantly more pronounced and longer-lasting flow increase than did 40 patients with a ratio above this level. On Day 1, the median CBF increase in the ipsilateral hemisphere was 61% and 24% in the two groups, respectively (p < 0.01). A significant improvement in side-to-side asymmetry, resulting from a higher gain in the ipsilateral hemisphere, occurred in the low pressure ratio group, while the hemispheric asymmetry on average was unchanged in the high pressure ratio group. This relative hyperemia was most pronounced 2 to 4 days following reconstruction. The marked hyperemia, absolute as well as relative, in patients with a low ICA/CCA pressure ratio suggests a temporary impairment of autoregulation. Special care should be taken to avoid postoperative hypertension in such patients, who typically have preoperative hypoperfusion, to avoid the occurrence of cerebral edema or hemorrhage.

scholarly journals Regional Anesthesia is Associated With Decreased Postoperative Hypertension in Patients Undergoing Eversion Carotid Endarterectomy

2016 ◽  
Vol 64 (3) ◽  
pp. 850
Author(s):  
Felecia Jinwala ◽  
Justin Oh ◽  
Viktor Dombrovskiy ◽  
Khanjan Nagarsheth ◽  
Saum Rahimi
Keyword(s):  
Carotid Endarterectomy ◽  
Regional Anesthesia ◽  
Postoperative Hypertension

Hyperglycemia Independently Increases the Risk of Perioperative Stroke, Myocardial Infarction, and Death after Carotid Endarterectomy

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1066-1073 ◽  
Author(s):  
Matthew J. McGirt ◽  
Graeme F. Woodworth ◽  
Benjamin S. Brooke ◽  
Alexander L. Coon ◽  
Shamik Jain ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Carotid Endarterectomy ◽  
Transient Ischemic Attack ◽  
Multivariate Logistic Regression Analysis ◽  
Interquartile Range ◽  
Morbidity And Mortality ◽  
Perioperative Stroke ◽  
Surgical Critical Care ◽  
Increased Risk ◽  
Ischemic Attack

Abstract OBJECTIVE: Clinical and experimental evidence suggests that hyperglycemia lowers the neuronal ischemic threshold, potentiates stroke volume in focal ischemia, and is associated with morbidity and mortality in the surgical critical care setting. It remains unknown whether hyperglycemia during carotid endarterectomy (CEA) predisposes patients to perioperative stroke and operative related morbidity and mortality. METHODS: The clinical and radiological records of all patients undergoing CEA and operative day glucose measurement from 1994 to 2004 at an academic institution were reviewed and 30-day outcomes were assessed. The independent association of operative day glucose before CEA and perioperative morbidity and mortality were assessed via multivariate logistic regression analysis. RESULTS: One thousand two hundred and one patients with a mean age of 72 ± 10 years (748 men, 453 women) underwent CEA (676 asymptomatic, 525 symptomatic). Overall, stroke occurred in 46 (3.8%) patients, transient ischemic attack occurred in 19 (1.6%), myocardial infarction occurred in 19 (1.6%), and death occurred in 17 (1.4%). Increasing operative day glucose was independently associated with perioperative stroke or transient ischemic attack (Odds ratio [OR], 1.005; 95% confidence interval [CI], 1.00–1.01; P = 0.03), myocardial infarction (OR, 1.01; 95% CI, 1.004–1.016; P = 0.017), and death (OR, 1.007; 95% CI, 1.00–1.015; P = 0.04). Patients with operative day glucose greater than 200 mg/dl were 2.8-fold, 4.3-fold, and 3.3-fold more likely to experience perioperative stroke or transient ischemic attack (OR, 2.78; 95% CI, 1.37–5.67; P = 0.005), myocardial infarction (OR, 4.29; 95% CI, 1.28–14.4; P = 0.018), or death (OR, 3.29; 95% CI, 1.07–10.1; P = 0.037), respectively. Median and interquartile range length of hospitalization was greater for patients with operative day glucose greater than 200 mg/dl (4 d [interquartile range, 2–15 d] versus 3 d [interquartile range, 2–7 d]; P &lt; 0.05). CONCLUSION: Independent of previous cardiac disease, diabetes, or other comorbidities, hyperglycemia at the time of CEA was associated with an increased risk of perioperative stroke or transient ischemic attack, myocardial infarction, and death. Strict glucose control should be attempted before surgery to minimize the risk of morbidity and mortality after CEA.

scholarly journals Comparation of influence general and regional anesthesia on basic haemodynamic parameters during carotid endarterectomy

2004 ◽  
Vol 51 (3) ◽  
pp. 37-43 ◽  
Author(s):  
R. Sindelic ◽  
G. Vlajkovic ◽  
Lazar Davidovic ◽  
B. Vujanac ◽  
M. Vjestica
Keyword(s):  
Blood Pressure ◽  
Carotid Endarterectomy ◽  
Surgical Techniques ◽  
Anesthetic Technique ◽  
Cerebral Stroke ◽  
Induction Agent ◽  
Haemodynamic Parameters ◽  
Arteria Carotis ◽  
Haemodynamic Changes ◽  
Plexus Block

Carotid endarterectomy (CEA) is a preventive operation to reduce the incidence of embolic and thrombotic cerebral stroke. CEA carries a significant perioeperartive mortality rate from stroke and myocardial infarction, which may even approach 5%. Thus, anesthetic and surgical techniques are constantly under scrutiny to try to reduce this relatively high incidence of morbidity and mortality. Anesthetic technique for CEA is divided to general (GA) and regional (RA) anesthesia, performed by cervical plexus block. The aim this study was to examine changes of basic haemodynamic parameters, which routinely fallows during CEA in condition of GA and RA. After obtaining institutional approval and informed consent, we randomized 50 patients scheduled for CEA (Tab.1) in two groups (GA and RA). We fallow blood pressure: systolic (BPs), mean (BPm), diastolic (BPd), heart rate (HR), and RPP index at the examined patients. The examination performed in six control times: before induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes after cross clamping of arteria carotis (T3), 5 minutes after declamping arteria carotis (T4), 10 minutes (T5) and 2 hours after operation (T6). The results of study shows significant changes of blood pressure (BPs and BPm) and RPP index in T2 time in patinets undergoing GA. The changes occurred under influence of induction agent thio- pental. These changes were in homeostatic range. In RA patinets, no haemodynamic changes registrated in control times. Therefore, from haemodynamic aspect RA was superior to GA.

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.

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