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.

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.

Carotid Endarterectomy with Regional Anesthesia

Neurosurgery ◽  
2001 ◽  
Vol 49 (3) ◽  
pp. 642-645 ◽  
Author(s):  
Robert E. Harbaugh ◽  
Harold J. Pikus
Keyword(s):  
Hospital Stay ◽  
General Anesthesia ◽  
Carotid Endarterectomy ◽  
Causal Relationship ◽  
Regional Anesthesia ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
Senior Author ◽  
Substantial Decrease ◽  
Surgical Experience

Abstract THE SENIOR AUTHOR (REH) has changed his technique for performing carotid endarterectomy from the use of general anesthesia to the use of cervical block anesthesia. Because a randomized study was not performed, it is difficult to separate effects of increased surgical experience from those caused by a change in anesthetic regimen. Nonetheless, there has been a substantial decrease in complications, length of hospital stay, and costs concomitant with the change to regional anesthesia; we think there is a causal relationship (11). The use of cervical block anesthesia has practically eliminated the non-stroke-related complications associated with carotid endarterectomy in our practice. The technique for performing carotid endarterectomy under cervical block anesthesia is described in detail.

“Aspirin - resistance”? A few critical considerations on definition, terminology, diagnosis, clinical value, natural course of atherosclerotic disease, and therapeutic consequences

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 429-438 ◽  
Author(s):  
Berent ◽  
Sinzinger
Keyword(s):  
Platelet Function ◽  
Point Of Care ◽  
Aspirin Resistance ◽  
Point Of View ◽  
Evidence Based ◽  
Platelet Function Tests ◽  
Clinical Value ◽  
Vascular Events ◽  
Therapeutic Consequences ◽  
Function Tests

Based upon various platelet function tests and the fact that patients experience vascular events despite taking acetylsalicylic acid (ASA or aspirin), it has been suggested that patients may become resistant to the action of this pharmacological compound. However, the term “aspirin resistance” was created almost two decades ago but is still not defined. Platelet function tests are not standardized, providing conflicting information and cut-off values are arbitrarily set. Intertest comparison reveals low agreement. Even point of care tests have been introduced before appropriate validation. Inflammation may activate platelets, co-medication(s) may interfere significantly with aspirin action on platelets. Platelet function and Cox-inhibition are only some of the effects of aspirin on haemostatic regulation. One single test is not reliable to identify an altered response. Therefore, it may be more appropriate to speak about “treatment failure” to aspirin therapy than using the term “aspirin resistance”. There is no evidence based justification from either the laboratory or the clinical point of view for platelet function testing in patients taking aspirin as well as from an economic standpoint. Until evidence based data from controlled studies will be available the term “aspirin resistance” should not be further used. A more robust monitoring of factors resulting in cardiovascular events such as inflammation is recommended.

A Comparison of General Anesthesia and Regional Anesthesia as a Risk Factor for Deep Vein Thrombosis Following Hip Surgery: A Critical Review

1990 ◽  
Vol 64 (04) ◽  
pp. 497-500 ◽  
Author(s):  
Martin H Prins ◽  
Jack Hirsh
Keyword(s):  
Deep Vein Thrombosis ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Lower Incidence ◽  
Hip Surgery ◽  
Level Of Evidence ◽  
Vein Thrombosis ◽  
Postoperative Thrombosis ◽  
High Level ◽  
Deep Vein

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

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