A Study of Cognitive Dysfunction in Patients Having Carotid Endarterectomy Performed with Regional Anesthesia

Abstract

BACKGROUND In previous studies, we found that approximately 25% of patients having carotid endarterectomy with general anesthesia (CEA general) develop cognitive dysfunction compared with a surgical control Group 1 day and 1 mo after surgery. In this study, we tested the hypothesis that patients having CEA with regional anesthesia (CEA regional) will develop significant cognitive dysfunction 1 day after surgery compared with a control group of patients receiving sedation 1 day after surgery. We did not study persistence of dysfunction. METHODS To test this hypothesis, we enrolled 60 patients in a prospective study. CEA regional was performed with superficial and deep cervical plexus blocks in 41 patients. The control group consisted of 19 patients having coronary angiography or coronary artery stenting performed with sedation. A control group is necessary to account for the “practice effect” associated with repeated cognitive testing. The patients from the CEA regional group were enrolled at New York Medical Center and the control group at Columbia-Presbyterian Medical Center. The cognitive performance of all patients was evaluated using a previously validated battery of neuropsychometric tests. Differences in performance, 1 day after compared with before surgery, were evaluated by both event-rate and group-rate analyses. RESULTS On postoperative day 1, 24.4% of patients undergoing CEA regional had significant cognitive dysfunction, where “significant” was defined as a total deficit score ≥2 SD worse than the mean performance in the control group. CONCLUSIONS Patients undergoing CEA regional had an incidence of cognitive dysfunction which was not different than patients having CEA general as previously published and compared with a contemporaneously enrolled group.

Age-dependent effects of carotid endarterectomy or stenting on cognitive performance

“…Furthermore, significantly higher levels of S100β as a marker of blood–brain barrier function and brain lesions were detected in the general anesthesia group compared to the local anesthesia group in that study [47]. In contrast to these findings, the incidence of cognitive deterioration after CEA did not differ between two groups of patients undergoing CEA with general or regional anesthesia a recent study by Heyer et al [48]. Although a potential age-related interaction between general anesthesia and cognitive outcome after CEA has not been specifically studied, the use of general anesthesia could at least partially have contributed to the cognitive decline in the older CEA patients.…”

Radiographic absence of the posterior communicating arteries and the prediction of cognitive dysfunction after carotid endarterectomy

“…4,10 These tests were chosen to collectively represent a broad range of cognitive domains-motor, visuospatial, verbal memory, and executive function-in accordance with recommendations from a consensus statement on the assessment of neurobehavioral outcomes after cardiac surgery. 7,24,30 All patients were evaluated preoperatively and 24 hours postoperatively with neuropsychometric testing.…”

Endarterectomia carotídea: revisão de 10 anos de prática de anestesia geral e locorregional num hospital terciário em Portugal

“…Alguns estudos abordaram esse tema, mas com pequenas amostras e resultados divergentes. [23][24][25][26][27] Existem algumas limitações neste estudo. Trata-se de um retrospecto e como tal dependeu da consulta do processo clínico par a a identificação das complicações perioperatórias.…”