Local versus general anaesthesia for carotid endarterectomy

Carotid endarterectomy in the acute phase of stroke-in-evolution is safe and effective in selected patients

“…Most surgeons perform CEA under general anesthesia, however, and in such cases, we also recommend systematic shunting because no monitoring is 100% reliable. 21 Under local anesthesia, we believe that poor tolerance to clamping is more reliably detectable; therefore, in the absence of supportive clinical trial evidence, we and others [22][23][24] challenged routine shunting in awake patients, with good results.…”

Carotid endarterectomy in the acute phase of crescendo cerebral transient ischemic attacks is safe and effective

“…In our department, we routinely perform CEA under either general or local anesthesia. However, we and others [24][25][26][27][28][29] are convinced that, in patients with multiple-severe comorbidities (high general risk patients) and/or severe contralateral carotid steno-occlusive disease (high local risk patients), local anesthesia with a simple superficial block has several advantages over regional or general anesthesia, and that local anesthesia has contributed to the good results observed in this series. Although the expected benefit of local anesthesia was not significant in the recent General Anaesthesia versus Local Anaesthesia for Carotid Endarterectomy (GALA) trial 30 nor in other six previous randomized trials, 28 it must be admitted that the GALA trial had several biases, and that randomized trials are not adapted to show a significant difference between the two anesthetic techniques since, before randomization, patients must be deemed suitable to be operated upon with the two techniques, which introduces a bias for non-randomization of patients who are most at risk; that is to say precisely those the most likely to benefit from local anesthetic.…”

Anästhesie zur Karotischirurgie

“…Tab. 7; [71]). Da die Aussagekraft von retrospektiven Arbeiten designbedingt erheblich eingeschränkt ist, können diese allenfalls Hypothesen generierend wirken, nicht aber als evidenzbasierte Grundlage im Vergleich zwischen Regional-und Allgemeinanästhesie dienen.…”