General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis

Harky, Amer; Chan, Jeffrey Shi Kai; Kot, Thompson Ka Ming; Sanli, Dilan; Rahimli, Rashad; Belamaric, Zlatka; Ng, Magar; Kwan, Ian Yu Young; Bithas, Christiana; Makar, Ragai R.; Chandrasekar, R.; Dimitri, Sameh

doi:10.1053/j.jvca.2019.03.029

Cited by 45 publications

(30 citation statements)

References 57 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Authors reported RCTs showed no significant difference between the outcomes of GA and LA in patients who underwent CEA. 14 However, when non-randomized studies with larger sample sizes were included, a small but statistically significant difference was demonstrated that CEAs under LA were associated with lower odds of stroke cardiac complications (OR: 0.59), and an in-hospital mortality (OR: 0.72) compared with CEAs under GA. 14 A more current evaluation of CEA and CAS data from the SVS-VQI looked at the effect of anesthesia type on hospital outcomes. 2 Of the total 75,319 CEA cases, GA was used in 68,635 (91.1%) and associated with a higher odds of postoperative MI, acute CHF and hemodynamic instability compared to LA.…”

Section: Discussionmentioning

confidence: 99%

The study of transcarotid artery revascularization under local versus general anesthesia with results from the Society for Vascular Surgery Vascular Quality Initiative

et al. 2020

View full text Add to dashboard Cite

Objective The primary purpose of this study was to examine any potential difference in clinical outcomes between transcarotid artery revascularization performed under local anesthesia compared with general anesthesia by utilizing a large national database. Methods The primary outcome of the study was a composite endpoint of postoperative in-hospital stroke, myocardial infarction and mortality following transcarotid artery revascularization for the index procedure. Secondary outcomes included a composite outcome of postoperative in-hospital stroke, transient ischemic attack, myocardial infarction and mortality along with several subsets of its components and each individual component, flow reversal time (min), radiation dose (GY/cm2), contrast volume utilized (mL), total procedure time (min), extended total length of stay (>1 day) and extended postoperative length of stay (>1 day). Statistical analyses employed both descriptive measures to characterize the study population and analytic measures such as multivariable mixed-effect linear and logistic regressions using both unmatched and propensity-score matched cohorts. Results A total of 2609 patients undergoing transcarotid artery revascularization between the years 2016 and 2018 in the US were identified, with 82.3% performed under general anesthesia and 17.7% under local anesthesia. The primary composite outcome was observed in 2.3% of general anesthesia patients versus 2.6% of local anesthesia patients ( p = 0.808). The rate of postoperative transient ischemic attack and/or myocardial infarction was 1.6% with general anesthesia versus 1.1% with local anesthesia ( p = 0.511). For adjusted regression analysis, general anesthesia and local anesthesia were comparable in terms of primary outcome (OR: 0.72; 95% CI: 0.27–1.93, p = 0.515). As for the secondary outcomes, no significant differences were found except for contrast, where the results demonstrated significantly less need for contrast with procedures performed under general anesthesia (coefficient: 4.94; 95% CI: 1.34–8.54, p = 0.007). A trend towards significance was observed for lower rate of postoperative transient ischemic attack and/or myocardial infarction (OR: 0.33; 95% CI: 0.09–1.18, p = 0.088) and lower flow reversal time under local anesthesia (coefficient: –0.94: 95% CI: –2.1–0.22, p = 0.111). Conclusions Excellent outcomes from transcarotid artery revascularization for carotid stenosis were observed in the VQI database between the years 2016 and 2018, under both local anesthesia and general anesthesia. The data demonstrate the choice of anesthesia for transcarotid artery revascularization does not appear to have any effect on clinical outcomes. Surgical teams should perform transcarotid artery revascularization under the anesthesia type they are most comfortable with.

show abstract

Section: Discussionmentioning

confidence: 99%

The study of transcarotid artery revascularization under local versus general anesthesia with results from the Society for Vascular Surgery Vascular Quality Initiative

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The effect of off‐pump procedure in stroke risk reduction is worth investigating. These are all part of an effort to optimize surgical stroke prevention, which encompasses also other areas such as the choice of anaesthetic technique in CEA …”

Section: Discussionmentioning

confidence: 99%

Concomitant severe carotid and coronary artery diseases: a separate management or concomitant approach

et al. 2019

Self Cite

View full text Add to dashboard Cite

Objective: To systematically compare outcomes between patients with asymptomatic carotid artery diseases (>80% stenosis) that had undergone staged carotid endarterectomy (CEA) before coronary artery bypass grafting (CABG) vs simultaneous CEA and CABG. Methods: A comprehensive electronic search of MEDLINE, Scopus, EMBASE, and Ovid from their inception up till August 2018 was performed to identify all studies comparing staged CEA followed by CABG to simultaneous CEA and CABG. Primary outcome measure was postoperative stroke, and secondary measures were myocardial infarction (MI) and 30‐day mortality rates. Results: A total of 67 953 patients were analyzed from 11 articles. There was higher rate of previous stroke in the staged cohort (2.64% vs 2.32%; odds ratio [OR], 0.81; 95% confidence interval [CI; 0.66, 0.99]; P = .040). There was no difference in previous MI (P = .57) or unstable angina (P = .08) among both cohorts. Postoperatively, there were higher stroke rates (3.64% vs 2.83%; OR, 0.72; 95% CI [0.62‐0.89]; P < .0001), operative mortality (4.32% vs 3.58%; OR, 0.90; 95% CI [0.83‐0.98]; P = .02), and 30‐day mortality (4.40% vs 3.58%; OR, 0.86; 95% CI [0.78‐0.96]; P = .006) in the simultaneous cohort. However, length of stay was significantly shorter in the simultaneous cohort (11.9 days vs 12.6 days; weighted mean difference 3.14 [0.77‐5.51]; P = .009). There were no significant differences in 1‐year mortality (P = .33), MI rates (P = .08), and rates of transient neurological deficits (P = .06). Conclusion: The results from this study favors staged CEA with CABG with lower incidence of postoperative stroke, operative, and 30‐day mortality. A larger study, ideally a randomized controlled trial, is required to address the superiority of each technique.

show abstract

“…The relative benefits of general vs. local/regional anaesthesia have been investigated within other patient populations who pose a similar clinical risk and physiological challenge to patients who have suffered an acute stroke. Despite several theoretical benefits, it has not been possible to show that general anaesthesia is associated with a meaningful difference in outcome in patients having carotid endarterectomy or surgical repair of a proximal femoral fracture .…”

Section: Advantages and Disadvantages Of General Anaesthesia (Includimentioning

confidence: 99%

Is blood pressure maintenance more important than type of anaesthesia for patients undergoing mechanical thrombectomy after ischaemic stoke?

Wiles

2020

Anaesthesia

View full text Add to dashboard Cite

General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis

Cited by 45 publications

References 57 publications

The study of transcarotid artery revascularization under local versus general anesthesia with results from the Society for Vascular Surgery Vascular Quality Initiative

The study of transcarotid artery revascularization under local versus general anesthesia with results from the Society for Vascular Surgery Vascular Quality Initiative

Concomitant severe carotid and coronary artery diseases: a separate management or concomitant approach

Is blood pressure maintenance more important than type of anaesthesia for patients undergoing mechanical thrombectomy after ischaemic stoke?

Contact Info

Product

Resources

About