Resection of a large carotid artery aneurysm under cervical epidural anaesthesia

Abstract

Carotid artery aneurysm is a rare arterial aneurysm that should be considered in the differential diagnosis of cervical and posterior pharyngeal masses. The purpose of the present article was to report a carotid artery aneurysm in a patient in whom cervical blockade, the common anaesthetic method, was not possible due to the location of the aneurysm. In this case, the surgeon decided to resect the aneurysm under cervical epidural anaesthesia. As the patient was awake during the operation, the continuous evaluation of her neurological status was possible and thus, it was possible to diagnose insufficient perfusion or brain dysfunction promptly while the carotid artery was clamped. Cervical epidural anaesthesia provides careful monitoring of the neurological function and early diagnosis of possible brain ischaemia. Therefore, the application of this method in resecting carotid artery aneurysm by an experienced anaesthetist is safe and acceptable.

Cervical epidural analgesia in current anaesthesia practice: systematic review of its clinical utility and rationale, and technical considerations

“…Three reports used epidural nerve stimulation to identify and introduce the catheter. 5 12 14 Complications Dural punctures were reported in three reports [(n=1/50), 10 (n=2/ 394), 25 and (6.7% in group 2) 74 ]; respiratory difficulties to complete paralysis were reported in four reports [(n=1/7), 15 (n=1/15), 18 (n=3/394), 25 and (n=1) 28 ]; neurological complications were reported in four reports [( paraesthesia of the arm), 7 (right hemiparesis and Babinski sign), 11 (crus spasm and burning arm pain), 15 and (seizure) 26 ]; technical failures were reported in four reports [(n=1), 9 (n=1/3), 26 (n=1/50), 35 and (20% blocks at C4-5 were reported 57 ]; and serious haemodynamic and cardiac complications were reported in five reports. 22 25 31 33 46 There were no deaths reported; however, significant long-term morbidity and cardiac arrest were reported.…”