Comparison Between Local and General Anesthesia for Carotid Endarterectomy: Early and Late Results

Gürer, Onur; Yapıcı, Fikri; Yapıcı, Nihan; Özler, Azmi; Işık, Ömer

doi:10.1177/1538574411431345

Cited by 19 publications

(16 citation statements)

References 42 publications

(32 reference statements)

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“…and deaths were similar in the 2 groups at long-term follow-up (48) . However, the rate of shunt placement as well as operative time was lower in LA group than the general anesthesia group.…”

Section: Review Articlementioning

confidence: 69%

Carotid Endarterectomy in Awake Patient: Review Article

Erdinç¹

2019

ejcm

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Cardiac mortality and morbidity in patients undergoing carotid surgery is between 0.7% and 7.1%. Although surgical techniques used in carotid surgery varies, there are differences in anesthesia techniques and the results are different. The advantages and disadvantages of anesthesia techniques are discussed in several studies and various results have been obtained. These different results involve the acquisition or loss of anesthesia technique, even if the patient group is the same. Carotid surgery under loco/regional anaesthesia may be thought easy. Although the complex structure of the head and neck region takes difficulty of during surgery, direct cerebral monitorization in the awake patient increases the success rate of the surgery. In this review we will explain the carotid endarterectomy management in the awake patient.

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Section: Review Articlementioning

confidence: 69%

Carotid Endarterectomy in Awake Patient: Review Article

Erdinç¹

2019

ejcm

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“…Research has shown local anaesthetic to be safe and efficient for internal carotid endarterectomy (26). Gurer and colleagues showed that it reduced operation time, shunt usage, hospitalisation time and permanent stroke rates in this procedure (27). 23 patients underwent TAVI via carotid access under local anaesthetic in this systematic review.…”

Section: Surgical Technique and Equipmentmentioning

confidence: 81%

“…It also allowed for a 'cross-clamp test' to be performed, which if failed, allowed the placement of a temporary carotid shunt similar to standard carotid endarterectomy practice under local anaesthetic (26,27). route, but also subclavian and transaortic) (28).…”

Section: Neurological Complicationsmentioning

confidence: 99%

A systematic review of transcatheter aortic valve implantation via carotid artery access

Stonier

Harrison

Choong

2016

International Journal of Cardiology

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& Keywords BackgroundThe carotid artery is a novel access route for transcatheter aortic valve implantation (TAVI). This may represent a viable alternative in patients unsuitable for TAVI via traditional transfemoral access, up to 20%, as well as other access routes such as subclavian, transapical and aortic. This systematic review summarises the current evidence for its safety and feasibility. Methods A systematic review was conducted as per the Preferred Reporting Instructions forSystematic Reviews and Meta-analysis (PRISMA) guidelines using five electronic databases. Results16 studies were identified, including three prospective cohort studies, one retrospective cohort study, three case series and eight case reports. Data on 74 patients (mean age 76.9 years) was extracted including pre-operative work-up, technical procedure details and outcomes.This found 1 intraoperative death, 2 further deaths within 30 days, two incidences of transient ischaemic attack, no incidences of stroke, myocardial infarction, carotid A C C E P T E D M A N U S C R I P T ACCEPTED MANUSCRIPT3 access site complications or infection, 1 patient required new dialysis and 1 patient had an intraoperative dissection which resolved. Follow-up from 30 days to 1 year showed symptomatic improvement and echocardiographic improvement in line with those seen in transfemoral TAVI. ConclusionsThe available data on TAVI via carotid access demonstrate technical feasibility with comparable outcomes to other traditional access routes. A low number of patients, heterogeneous clinical endpoints and relatively short follow-up periods limit formal meta-analysis and firmer conclusions. For patients in which other access routes are impossible, TAVI via carotid access represents a viable and potentially crucial alternative in patients who might otherwise be untreatable.

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“…Literature searches of the databases identified 1294 articles. Following the screening of retrieved titles or abstracts and after assessing the full texts of relevant reports, we selected 33 articles for analysis (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy

et al. 2018

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Controversy exists regarding the best choice of anaesthesia for carotid endarterectomy. We aimed to evaluate the peri-operative outcomes of local vs. general anaesthesia for carotid endarterectomy. We conducted a systematic search of electronic information sources and applied a combination of free text and controlled vocabulary searches adapted to thesaurus headings, search operators and limits in each of the electronic databases. We defined peri-operative stroke, transient ischaemic attack, mortality and myocardial infarction as the primary outcome measures. We identified 12 randomised controlled trials and 21 observational studies reporting a total of 58,212 patients undergoing carotid endarterectomy under local or general anaesthesia. Analysis of observational studies demonstrated that local anaesthesia was associated with a significantly lower incidence of stroke (odds ratio (OR (95% CI) 0.66 (0.55-0.80), p < 0.0001), transient ischaemic attack (0.52 (0.38-0.70), p < 0.0001), myocardial infarction (0.55 (0.41-0.75), p = 0.0002) and mortality (0.72 (0.56-0.94), p = 0.01) compared with general anaesthesia. Analysis of randomised controlled trials did not find a significant difference in the risk of stroke (0.92 (0.67-1.28), p = 0.63), transient ischaemic attack (2.20 (0.48-10.03), p = 0.31), myocardial infarction (1.25 (0.57-2.72), p = 0.58) or mortality (0.61 (0.35-1.05), p = 0.07) between local and general anaesthesia. On trial sequential analysis of the randomised trials, the Z-curve did not cross the α-spending boundaries or futility boundaries for stroke, mortality and transient ischaemic attack, suggesting that more trials are needed to reach conclusive results. Our meta-analysis of observational studies suggests that local anaesthesia for carotid endarterectomy may be associated with lower peri-operative morbidity and mortality compared with general anaesthesia. Although randomised studies have not confirmed any advantage for local anaesthesia, this may be due to a lack of pooled statistical power in these trials.

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Comparison Between Local and General Anesthesia for Carotid Endarterectomy: Early and Late Results

Cited by 19 publications

References 42 publications

Carotid Endarterectomy in Awake Patient: Review Article

Carotid Endarterectomy in Awake Patient: Review Article

A systematic review of transcatheter aortic valve implantation via carotid artery access

Meta‐analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy

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