Detailed comparison of regional and general anesthesia for carotid endarterectomy

Muskett, Alan; McGreevy, James; Miller, Michael

doi:10.1016/0002-9610(86)90450-2

Cited by 57 publications

(11 citation statements)

References 6 publications

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“…It has been demonstrated in many clinical studies that CEA can be performed with a low perioperative risk of stroke and death, 4,5,11,16,18 and there is no compelling evidence to indicate that the type of anesthetic used for CEA has an effect on the incidence of perioperative stroke morbidity or mortality. 1,3,[6][7][8]14,15,17,18,[20][21][22][23] For example, in a retrospective study conducted by Allen and colleagues, 1 in which 361 CEAs performed after administration of a general anesthetic and 318 performed after a cervical block anesthetic were compared, no statistically significant difference was found in the incidence of stroke and death between the groups. This concurs with our analysis.…”

Section: Incidences Of Stroke Morbidity and Mortalitymentioning

confidence: 99%

“…A reduction in cardiopulmonary complications as a result of using a regional anesthetic has been reported in previous studies. 1,7,10,17,20 In a multivariate analysis of patients who underwent CEA, the use of a general anesthetic, patient age older than 75 years, and operative time longer than 3 hours were all associated with cardiopulmonary complications after CEA. 1 In the classic paper by Sundt, et al, 21 on the assessment of risk in patients undergoing CEA in which a general anesthetic was used, the authors evaluated the effects of medical, neurological, and angiographic risk factors on the incidence of perioperative morbidity and mortality.…”

Section: Cardiopulmonary Complicationsmentioning

confidence: 99%

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Clinical outcomes after carotid endarterectomy: comparison of the use of regional and general anesthetics

Papavasiliou¹,

Magnadottir²,

Gonda³

et al. 2000

Journal of Neurosurgery

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Section: Incidences Of Stroke Morbidity and Mortalitymentioning

confidence: 99%

Section: Cardiopulmonary Complicationsmentioning

confidence: 99%

Clinical outcomes after carotid endarterectomy: comparison of the use of regional and general anesthetics

Papavasiliou¹,

Magnadottir²,

Gonda³

et al. 2000

Journal of Neurosurgery

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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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“…(26) çalışmalarında kardiyopulmoner komplikasyonlar arasındaki fark daha da büyüktür (LA: %2,8, GA: %12,9). GA ile opere edilen hastalar daha fazla intraoperatif sıvı alırlar; yoğun bakımda ve hastanede kalış süreleri de LA ile opere edilenlere göre daha uzundur (27). GA ile opere olan hastalarda postoperatif bulantı ve kusmanın daha sık görülmesi de hastanede kalış sürelerini ve maliyeti arttırır (28).…”

Section: Introductionunclassified

“…Lokal hemorajinin tanımı ise çalışmaların çoğunda farklılık gösterip, bir standartizasyona konamamıştır. Lokal hemoraji kiminde reoperasyon ile boşaltılan hematomu tanımlarken, kimilerinde de büyüklükleri farklı herhangi bir hematom koleksiyonudur (25)(26)(27).…”

Section: Introductionunclassified

General Anesthesia Management for Carotid Endarterectomy Surgery

Kerem¹,

Gümüş²,

Alagöl³

2014

JAREM

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Karotis endarterektomileri proflaktik operasyonlardır ve genel, lokal veya rejyonel anestezi altında gerçekleştirilebilirler. Karotis endarterektomi operasyonlarının mevcut pratik uygulamalarında anestezist ve cerrah genellikle en konforlu olabilecek anestezi tekniğini tercih ederler. Lokal anestezi uygulaması bilinçli hastanın direkt nörolojik monitorizasyonunu sağladığı için avantajlıdır. Ancak bu yöntem cerrahlar ve hastalar için stresli olabilir. Buna karşın genel anestezi altında uygulanan karotis endarterektomilerinde ise serebral iskeminin tespiti çok zor olabilir. Serebral iskeminin tespiti için pek çok monitör ve teknik vardır, fakat hiçbiri tam anlamıyla efektif ve güvenilir değildir. Ek olarak karotis endarterektomi operasyonu geçirecek hastalar hipertansiyon hastasıdırlar ve operasyon sırasında önemli derecede kalp krizi riski taşırlar. Hemodinamik stabilite için anestezi indüksiyonu dikkatlice yapılmalıdır. Direkt invazif arter basıncı, beş yollu elektrokardiyografi (EKG) ve ST segment analizi monitorize edilmelidir. Karotis arter klemplenmesine sekonder gelişebilecek serebral iskemi riskini azaltmak için yeterli serebral perfüzyon basıncı korunmalıdır. Normokarbinin, yeterli oksijenasyonun, giriş ortalama arter basıncına yakın bir arter basıcının sağlanması gerekir. Hatta ortalama arter basıncı seviyesi, giriş ortalama arter basıncının %20 kadar üzerinde tutulabilir. Karotis endarterektomilerinde peroperatif ve postoperatif riskin kontrolünde anestezistin rolü çok önemlidir. Bu cerrahi işlemin bütün aşamalarında tüm detaylara dikkat edilmesi ve güvenli bir anestezi yaklaşımı başarılı bir sonuca katkıda bulunur. Nörolojik sistemin ve kardiyovasküler fonksiyonların dikkatli bir şekilde değerlendirilmesi, optimum serebral ve kardiyovasküler perfüzyon basınçlarının sağlanması gereklidir.

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Detailed comparison of regional and general anesthesia for carotid endarterectomy

Cited by 57 publications

References 6 publications

Clinical outcomes after carotid endarterectomy: comparison of the use of regional and general anesthetics

Clinical outcomes after carotid endarterectomy: comparison of the use of regional and general anesthetics

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

General Anesthesia Management for Carotid Endarterectomy Surgery

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