Anesthesia Management for Carotid Endarterectomy: Review Article

Abstract

Atherosclerotic carotid artery disease is responsible from 20% to 25% of ischemic stroke events. Open carotid surgery and stent insertion are two main types of treatment procedures. Carotid endarterectomy (CEA) can be performed under general anaesthesia, regional anaesthesia (interscalen block, cervical plexus block either by landmark technique or by US guidance), combination of general and regional anaesthesia, regional anaesthesia with combination of periferic block. The aim of all anesthesic techniques is to prevent pain during the three painful periods (1. Skin incision, 2. Insertion of a retromandibular retractor, 3. Perivascular preparation) during CEA). All techniques have their own advantages and disadvantages. But there is no certain data about which one is superior to other. There is no consensus on anaesthetic choice for CEA. At present regional anaesthesia versus general anaesthesia for patients undergoing CEA is still debate topic. Improvements in medical theraphy, use of cerebral monitoring, better timing for surgery after ischemic events, better surgical techniques, increased use of ultrasound for regional anaesthesia improve procedural outcomes. Despite these improvements, anaesthesia management is still deciding according to surgeon and anaesthesiologist preferences, the patient's satisfaction and the conditions in the hospitals where we work.

Carotid Endarterectomy Under Carotid Sheath Block Combined with Superficial Cervical Plexus Block by Ultrasound Guidance

“…The results we obtained from our cases were consistent with the results of previous publications except Seidel et al [12]. As highlighted in previous publications, "right dose of the right drug placed in the right place" describes the gold standard of every peripheral block [1,14]. We thought that "right block combinations" should also be added to this philosophy while combining the regional blocks for CEA.…”

Carotid endarterectomy: A case study and literature review

“…(8) Improved procedural outcomes are due to the advances in medical therapy, cerebral monitoring, improved timing of surgery, improved surgical techniques and the use of ultrasound guided regional techniques. (9) In this case study we found that a combined general and local anaesthetic technique worked well minimising our use of opiates and allowing prompt emergence and neurological assessment.…”

Carotid Endarterectomy With Regional Anesthesia in Our Experience

“…These difficulties can be significantly overcome by preferring regional anesthesia (RA). Despite its negative aspects, such as requiring patient cooperation and some difficulties in pain control, RA is an excellent alternative to GEA due to its advantages, such as shortening the hospital stay and low risk of hemodynamic instability (3). However, the issue of which anesthesia method should be chosen in CEAs is still controversial.…”