Carotid endarterectomyA survey of UK anasthetic practice

Abstract

SummaryWe conducted a postal questionnaire survey of the members of the Vascular Anaesthesia Society of Great Britain and Ireland, asking questions about the provision of anaesthesia for carotid endartectomy. Of 215 respondents, 187 were currently providing anaesthesia for carotid endarterectomy. The majority of respondents (69%) always use general anaesthesia for this operation but 99/215 (46%) had some experience of regional anaesthesia for carotid endartectomy. Amongst those currently using regional anaesthesia, combined deep and super®cial cervical plexus block was the technique used by 71%. Other regional techniques used included local in®ltration and super®cial block alone. During regional anaesthesia, most (66%) anaesthetists used cerebral monitoring techniques such as stump pressure or transcranial Doppler as well as keeping the patient awake. However, in a signi®cant proportion of cases (37%) under general anaesthesia no cerebral monitoring was used. Reported surgical shunt insertion rates were lower in awake (mean 42%) patients than those receiving general anaesthesia (61%). Respondents using regional anaesthesia were more likely to feel that their technique was appropriate than those using general anaesthesia.

Regional anaesthesia for carotid endarterectomy: an audit over 10 years

“…23 According to a questionnaire distributed to vascular anaesthetists in the UK, the combined CPB is still the most common technique of regional anaesthesia for carotid surgery. 24 However, the complication rate using superficial CPB alone is lower 3 4 13 17 25 and it is therefore possible that a comparison of superficial CPB rather than combined CPB with CE anaesthesia may produce even more dramatic differences. Two large series of CE anaesthesia for carotid surgery have been published to date.…”

Die Chirurgie der A. carotis in Regionalanästhesie - anästhesiologische, neurologische, chirurgische und ökonomische Aspekte

“…Demgegenüber stellten einzelne Studien eine Verminderung kardialer und neurologischer Komplikationen unter Regionalanästhesie fest [10,16]. Studienbasiert wurden zudem Hinweise publiziert, die bei Anwendung einer Regionalanästhesie auf einen geringeren Verbrauch an vasoaktiven Substanzen, weniger Shunteinlagen, kürzere Operations-und damit Anästhesiezeiten sowie auf eine Reduktion der Krankenhausverweildauer hinweisen [1,6,7]. In Bezug auf die Patientenzufriedenheit war zwischen den beiden Anästhesieverfahren bisher kein Unterschied feststellbar [11,12].…”

Somatosensorisch evozierte Potenziale und biochemische Marker neuronaler Defizite während Endarterektomie der A. carotis in Regionalanästhesie

“…In verschiedenen Arbeiten wird auf eine deutlich reduzierte Anzahl von temporären Shuntanlagen hingewiesen mit der mög-licherweise die Komplikationsrate, die mit einer Shuntanlage verbunden sein kann, reduziert wird [4,21]. Die Angaben in der Literatur differieren zwischen 7,4 % [15] und 42 % [19]. Originalarbeiten und Übersichten u. Mitarb.…”