Carotid Endarterectomy: Comparison Between General and Local Anesthesia. Revision of Our Experience With 428 Consecutive Cases

Ferrero, Emanuele; Ferri, Michelangelo; Viazzo, Andrea; Ferrero, Mauro; Gaggiano, Andrea; Berardi, Giuseppe; Pecchio, Alberto; Piazza, Salvatore; Cumbo, Pia; Nessi, Franco

doi:10.1016/j.avsg.2010.04.001

Cited by 19 publications

(11 citation statements)

References 11 publications

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“…The reason for dissatisfaction with GA were postoperative nausea and vomiting (7 patients), postoperative psychological alteration (3), and fear of GA (1) (►Table 3). The reasons for dissatisfaction with LA were intraoperative pain (9 patients), intraoperative discomfort and stress (5), and intraoperative breathing problems (2) (►Table 4). Of the GA group, 154 (96.9%) patients would prefer GA again, and of the LA group, 28 (60.9%) patients would prefer LA if operated on again (►Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Although both anesthetic procedures are considered equivalent, each presents its own advantages and disadvantages to both surgeon and anesthesiologist as well as to the patient. [1][2][3][4][5] The need for a measure of patient satisfaction and preference regarding GA or LA during CEA was discussed. 6,7 Both GA and LA are used in our department, and the type of anesthesia is chosen on an individual basis.…”

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Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

Mraček

Kletečka

Holečková

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background and Study Aims Both general and local anesthesia are used in our department for carotid endarterectomy (CEA). The decision as to which anesthetic technique to use during surgery is made individually. The aim of our study was to evaluate patient satisfaction and preference with the anesthesia type used. Material and Methods The satisfaction of a group of 205 patients with regard to anesthesia used and their future preferences were evaluated prospectively through a questionnaire. The reasons for dissatisfaction were assessed. Results CEA was performed under general anesthesia (GA) in 159 cases (77.6%) and under local anesthesia (LA) in 46 cases (22.4%). In the GA group, 148 patients (93.1%) were satisfied; 30 patients (65.2%) in the LA group were satisfied (p < 0.0001). The reason for dissatisfaction with GA were postoperative nausea and vomiting (7 patients), postoperative psychological alteration (3), and fear of GA (1). The reasons for dissatisfaction with LA were intraoperative pain (9 patients), intraoperative discomfort and stress (5), and intraoperative breathing problems (2). Of the GA group, 154 (96.9%) patients would prefer GA again, and of the LA group, 28 (60.9%) patients would prefer LA if operated on again (p < 0.0001). Overall, 172 patients (83.9%) would prefer GA in the future, and 33 patients (16.1%) would prefer LA. Conclusion Overall patient satisfaction with CEA performed under both GA and LA is high. Nevertheless, in the GA group, patient satisfaction and future preference were significantly higher. Both GA and LA have advantages and disadvantages for CEA. An optimal approach is to make use of both anesthetic techniques based on their individual indications and patient preference.

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

Mraček

Kletečka

Holečková

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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“…Literature searches of the databases identified 1294 articles. Following the screening of retrieved titles or abstracts and after assessing the full texts of relevant reports, we selected 33 articles for analysis (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

Meta‐analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy

et al. 2018

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Controversy exists regarding the best choice of anaesthesia for carotid endarterectomy. We aimed to evaluate the peri-operative outcomes of local vs. general anaesthesia for carotid endarterectomy. We conducted a systematic search of electronic information sources and applied a combination of free text and controlled vocabulary searches adapted to thesaurus headings, search operators and limits in each of the electronic databases. We defined peri-operative stroke, transient ischaemic attack, mortality and myocardial infarction as the primary outcome measures. We identified 12 randomised controlled trials and 21 observational studies reporting a total of 58,212 patients undergoing carotid endarterectomy under local or general anaesthesia. Analysis of observational studies demonstrated that local anaesthesia was associated with a significantly lower incidence of stroke (odds ratio (OR (95% CI) 0.66 (0.55-0.80), p < 0.0001), transient ischaemic attack (0.52 (0.38-0.70), p < 0.0001), myocardial infarction (0.55 (0.41-0.75), p = 0.0002) and mortality (0.72 (0.56-0.94), p = 0.01) compared with general anaesthesia. Analysis of randomised controlled trials did not find a significant difference in the risk of stroke (0.92 (0.67-1.28), p = 0.63), transient ischaemic attack (2.20 (0.48-10.03), p = 0.31), myocardial infarction (1.25 (0.57-2.72), p = 0.58) or mortality (0.61 (0.35-1.05), p = 0.07) between local and general anaesthesia. On trial sequential analysis of the randomised trials, the Z-curve did not cross the α-spending boundaries or futility boundaries for stroke, mortality and transient ischaemic attack, suggesting that more trials are needed to reach conclusive results. Our meta-analysis of observational studies suggests that local anaesthesia for carotid endarterectomy may be associated with lower peri-operative morbidity and mortality compared with general anaesthesia. Although randomised studies have not confirmed any advantage for local anaesthesia, this may be due to a lack of pooled statistical power in these trials.

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“…Surgical strategies including one-or two-stage operations have been suggested to minimize perioperative neurological and cardiac complications [16,17]. In a sequential retrospective study Ferrero et al [18] compared the results between LA and GA for 428 CEAs. In their study the morbi-mortality was not influenced by the type of anesthesia used for carotid surgery.…”

Section: Discussionmentioning

confidence: 99%

Carotid Endarterectomy: A Comparison on General and Local Anesthesia

Toktaş¹,

Goncu²,

Surer³

et al. 2015

Eur Res J

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Carotid Endarterectomy: Comparison Between General and Local Anesthesia. Revision of Our Experience With 428 Consecutive Cases

Cited by 19 publications

References 11 publications

Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

Meta‐analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy

Carotid Endarterectomy: A Comparison on General and Local Anesthesia

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