Carotid endarterectomy (CEA) is an integral part in the management of transient ischeamic attacks and strokes. The GALA trial in 2008 concluded that there is no significant difference in local or general anaesthetic for carotid endarterectomy (1).We conducted a survey on all vascular surgeons in England regarding their practise. Two hundred and twenty five completed questionnaires were received. A total of 123 (55%) conducted their CEA under LA. Postoperatively 71 (36%) were sent either to an ITU or HDU environment whereas the rest were managed on a vascular ward. Only 9(6%) were discharged within 24 h, whereas the majority (92%) were discharged 24-72 h postoperatively and 2% kept their patients in for longer. Most patients (69%) were seen once in clinic and discharged, 23% were seen for a year and 3% for 5 years. A percentage of 2% reviewed patients for longer and one surgeon did not follow the patients up.The majority of the local blocks (83%) were performed by the anaesthetist. The com-monest agent used was marcaine in varying concentrations (0.25-1%). The surgeons were only aware of the agent used 58% of the time. There was no consensus on the volume to be used. Most used volumes ranging from 20 to 40 ml whereas some used up to 60 ml.The purpose of our survey was to determine the routine practice of surgeons performing CEA in England and to compare it with evidence currently available. Our findings show a large variation in current practice. A large number of patients were still being sent to an ITU environment and being kept for over 24 h despite current evidence which suggest that 2 h of monitoring is sufficient to look for most major complications. LA CEA could reduce cost and is therefore likely to increase in popularity. LA has also been found to have a reduced rate of death and stoke compared with GA although not statistically significant. A new survey might give us more information on the situation now that the GALA data has been available for a while (2). References1 GALA Trial Collaborative Group. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 2008; 372: 2132-42. 2 Gomes M, Soares MO, Dumville JC et al. Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery (GALA Trial). Br J Surg 2010; 97: 1218-25. DisclosureNone.
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