Carotid Surgery Under Local Anesthesia in the Elderly

Abstract

Carotid endarterectomy in 39 elderly patients was carried out under local anesthesia and neuroleptic analgesia. There were no deaths within 30 days. Two patients required an intraoperative shunt because of signs of ischemic changes (aphasia, motor changes) during two-minute test cross-clamping. In two patients, transient vocal cord paresis was observed, and seven patients (18%) experienced immediate postoperative hypertension. Our results support the contention that in awake elderly patients the need for an intraoperative shunt can be accurately assessed by simple neurological monitoring. Carotid surgery under local anesthesia and neuroleptic analgesia appears to be a safe procedure, and is especially recommended for elderly patients with hypertension, diabetes mellitus or ischemic heart disease.

Simultaneous Bilateral Carotid Endarterectomy under Local Anesthesia

“…After superfi cial local anesthesia (lidocaine 1%) of the symptomatic left side, we proceeded with the usual steps: dissection of the left carotids, general Bilateral Carotid Endarterectomy Portinos and pulmonary complications, and appropriateness in ischemic cardiac disease. [3][4][5][6][7][8] In our case, although the cerebral insuffi ciency could be judged as serious, the patient did not display symptoms of hyperfusion syndrome. Local anesthesia may decrease the risk of hyperfusion syndrome by reducing both systolic and diastolic pressures and their fl uctuations.…”

“…2 Studies comparing local with general anesthesia in CEA have provided evidence of the benefits of local anesthesia: lower incidence of shunt, greater safety in the elderly, less perioperative hemodynamic instability, thorough assessment of neurologic function, fewer cardiac and pulmonary complications, and appropriateness in ischemic cardiac disease. 3 –8…”

Attitudinal barriers hindering adoption of Telepsychiatry among mental healthcare professionals: Israel as a case-study (Preprint)

“…The field of mental healthcare has been a late comer to this innovative process, with the introduction of online child psychiatry consultations being introduced in 2016 [28]. Telepsychology and telepsychiatry services for adults were initiated by some HMOs in 2019 [29], with online social workers and emergency services being added in 2020 due to the outbreak of COVID-19 pandemic [30,31].…”