Comparative evaluation of anesthesia methods for reconstructive carotid surgery

Abstract

The objective: to assess the impact of total intravenous and combined anesthesia (consisting of regional block and inhalation anesthesia with sevoflurane) on higher mental functions, frequency and nature of postoperative complications in carotid endarterectomy.Subjects and methods. A total of 190 patients with ipsilateral carotid stenosis exceeding 70%, or with the unstable atheromatous plaque were examined. CE was performed in 140 (73.6%) patients, while 50 (26.4%) patients underwent plasty with the autovenous patch. 60 patients had total intravenous anesthesia. The other 60 patients had combination anesthesia (cervical plexus block as per A. Yu. Paschuk + non-inhalation anesthesia with thiopental sodium). In 70 patients, low-flow inhalation anesthesia with sevoran and potentiation of the analgesic effect by bolus administration of fentanyl was performed. The parameters of central hemodynamics, cerebral blood flow, markers of cerebral damage, and state of higher mental functions were assessed.Results. Inhalation anesthesia with sevoflurane was characterized by decrease of total peripheral resistance index by 20% (p = 0.002) and SBP by 13% (p = 0.004) compared to baseline values. Moderate reduction of afterload was accompanied by normalization of cardiac and stroke indices. Optimization of the central hemodynamic parameters led to high levels of the linear velocity of cerebral blood flow and cerebral perfusion pressure which at the main stages of the operation did not differ from the control values. At the end of the operation, a statistically significant insignificant increase in intracranial pressure was noted (on average, by 4 mm Hg exceeded values at the previous stages, p = 0.014) and levels of markers of ischemic neuronal damage: the levels of antibodies to protein S-100 increased by 14% (p = 0.043), and NSE – by 2.8 μg/L. During inhalation anesthesia with sevoflurane, the lowest number of postoperative neurological and cardiac complications was recorded; they developed only in 6 (8.6%) patients and distributed equally. However, more pronounced postoperative cognitive dysfunction was noted when this method of anesthesia was used.Conclusion. Each method of anesthesia provided an unequal level of cerebral protection from ischemic damage which was manifested by a difference in the severity of disorders of higher mental functions, the number and nature of postoperative neurological complications.