Local versus general anaesthesia for carotid endarterectomy

Rerkasem, Amaraporn; Orrapin, Saritphat; Howard, Dominic P J; Nantakool, Sothida

doi:10.1002/14651858.cd000126.pub5

Cited by 20 publications

(18 citation statements)

References 57 publications

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“…CEA is strongly recommended by the guidelines of the European Stroke Organisation and the European Society for Vascular Surgery for patients with carotid artery stenosis greater than 70%, 9,10 because it is a surgery with few complications, it improves the quality of life, and significantly reduces the risk of stroke. 1,13,14 Similar results to the present study were also reported by Cruz Silva et al, 15 3.5%), death (0.9% vs. 1.4%), myocardial infarction (0.6% vs. 0.4%), local bleeding (7.7% vs. 7.8%), and shunt use. 14 Similarly, in our study, the type of anesthesia had no influence on the incidence of immediate postoperative complications or the average length of hospital stay.…”

Section: Discussionsupporting

confidence: 92%

Factors That Influence the Occurrence of Acute Postoperative Complications after Carotid Endarterectomy

Balmos

Mureşan

Brînzaniuc

et al. 2023

Journal of Cardiovascular Emergencies

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Background This study aimed to identify early postoperative complications after carotid endarterectomy and the factors that may influence their occurrence. Methods This was an observational, analytical, prospective study conducted over a period of 3 years in 2 university hospitals in Târgu Mureș, Romania. One hundred nineteen patients who underwent carotid endarterectomy for severe carotid stenosis were included. Statistical analysis was used to identify the independent factors with a direct influence on the acute complications in the first 48 h after carotid endarterectomy. Results We followed up on the acute postoperative complications occurring in the first 2 days after surgery. These were represented by a limited number of neurological complications and major neck hematomas. Among all comorbidities and risk factors, only advanced coronary artery disease (p = 0.05) and smoking (p = 0.03) were independent factors that directly influenced the occurrence of major neck hematomas. Operative time exceeding the median time of 90 minutes increased the risk of neurological complications (p = 0.02). The risk of major neck hematomas was also increased by preoperative treatment with anticoagulants (p = 0.01) and anticoagulants associated with antiplatelet therapy (p = 0.009). Conclusions This study has identified factors such as advanced coronary artery disease, smoking, operative time, and anticoagulant therapy that may be independently associated with an increased risk of acute postoperative complications after carotid endarterectomy.

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Section: Discussionsupporting

confidence: 92%

Factors That Influence the Occurrence of Acute Postoperative Complications after Carotid Endarterectomy

Balmos

Mureşan

Brînzaniuc

et al. 2023

Journal of Cardiovascular Emergencies

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“…However, other studies comparing general endotracheal and RA methods suggest no statistical difference. In these studies, the perioperative stroke risk in CEAs was reported to be 1.5-3% (13,14). Our study found the 30-day CVA rate to be 2.5%.…”

Section: Discussionsupporting

confidence: 46%

Carotid Endarterectomy With Regional Anesthesia in Our Experience

Mola

Deniz

Yaşar³

et al. 2022

Turkish Journal of Clinics and Laboratory

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Aim: Carotid endarterectomy (CEA) is a common revascularization option for carotid atherosclerosis. Regional anesthesia for CEA has become a preferred anesthesia technique in lots of centers. In this study, we present our experience with CEAs under regional anesthesia. Material and Methods: From 2019 to 2022, 271 patients who underwent CEA with regional anesthesia in two centers were included. Retrospectively, patient data, demographical characteristics, comorbidities, and radiological imaging features were enrolled by searching the hospital information system. The primary endpoint was to describe the outcomes. Results: Of the 271 participants, 202 were male and 69 were female. The male-to-female ratio is 74.5. The average age was 65.3±10,2. General anesthesia was maintained for two patients due to inadequate patient collaboration. The average operation time was 52±8.9 minutes. The mean X-clamp time was 14±2.5 minutes and the patient stayed in the intensive care unit for an average of 14±2 hours. The most common postoperative complication was bleeding (n=8). No cranial nerve damage was observed. There was no procedural death. Patients were discharged within an average of 4 days. Conclusion: Regional anesthesia can be safely performed for CEA. Considering patient preference and compliance, regional anesthesia is the first option for CEA operations in our routine. Keywords: carotid artery stenosis, carotid endarterectomy, regional anesthesia

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“…Extreme lability of blood pressure and heart rate in the peri-operative period is common with regional and general anaesthesia techniques. This is due to altered baseline carotid baroreceptor function and intra-operative manipulation of these baroreceptors [43] in the setting of patients with hypertension and atherosclerosis. Invasive arterial blood pressure monitoring should be used regardless of anaesthesia type.…”

Section: Carotid Endarterectomymentioning

confidence: 99%

Anaesthesia for vascular emergencies – a state of the art review

et al. 2022

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Summary In this state‐of‐the‐art review, we discuss the presenting symptoms and management strategies for vascular emergencies. Although vascular emergencies are best treated at a vascular surgical centre, patients may present to any emergency department and may require both immediate management and safe transport to a vascular centre. We describe the surgical and anaesthetic considerations for management of aortic dissection, aortic rupture, carotid endarterectomy, acute limb ischaemia and mesenteric ischaemia. Important issues to consider in aortic dissection are extent of the dissection and surgical need for bypasses in addition to endovascular repair. From an anaesthetist's perspective, aortic dissection requires infrastructure for massive transfusion, smooth management should an endovascular procedure require conversion to an open procedure, haemodynamic manipulation during stent deployment and prevention of spinal cord ischaemia. Principles in management of aortic rupture, whether open or endovascular treatment is chosen, include immediate transfer to a vascular care centre; minimising haemodynamic changes to reduce aortic shear stress; permissive hypotension in the pre‐operative period; and initiation of massive transfusion protocol. Carotid endarterectomy for carotid stenosis is managed with general or regional techniques, and anaesthetists must be prepared to manage haemodynamic, neurological and airway issues peri‐operatively. Acute limb ischaemia is a result of embolism, thrombosis, dissection or trauma, and may be treated with open repair or embolectomy, under either general or local anaesthesia. Due to hypercoagulability, there may be higher numbers of acutely ischaemic limbs among patients with COVID‐19, which is important to consider in the current pandemic. Mesenteric ischaemia is a rare vascular emergency, but it is challenging to diagnose and associated with high morbidity and mortality. Several peri‐operative issues are common to all vascular emergencies: acute renal injury; management of transfusion; need for heparinisation and reversal; and challenging postoperative care. Finally, the important development of endovascular techniques for repair in many vascular emergencies has improved care, and the availability of transoesophageal echocardiography has improved monitoring as well as aids in surgical placement of endovascular grafts and for post‐procedural evaluation.

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Local versus general anaesthesia for carotid endarterectomy

Cited by 20 publications

References 57 publications

Factors That Influence the Occurrence of Acute Postoperative Complications after Carotid Endarterectomy

Factors That Influence the Occurrence of Acute Postoperative Complications after Carotid Endarterectomy

Carotid Endarterectomy With Regional Anesthesia in Our Experience

Anaesthesia for vascular emergencies – a state of the art review

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