Examination of regional anesthesia for carotid endarterectomy

Pasin, Laura; Nardelli, Pasquale; Landoni, Giovanni; Cornero, Guglielmo; Magrin, S.; Tshomba, Yamume; Chiesa, Roberto; Zangrillo, Alberto

doi:10.1016/j.jvs.2015.03.074

Cited by 14 publications

(18 citation statements)

References 16 publications

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“…Regional anesthesia for CEA is considered to be safe and associated with a low rate of conversion to general anesthesia. [ 25 ] Possible concerns with regional techniques include remote access to the upper airway, stressful conversion of regional into general anesthesia when necessary, the need for patient cooperation, and the inadvertent subarachnoid or intravascular injection of local anesthetic [ Table 2 ]. [ 26 ]…”

Section: Methodsmentioning

confidence: 99%

General versus local anesthesia for carotid endarterectomy: Special considerations

et al. 2018

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Section: Methodsmentioning

confidence: 99%

General versus local anesthesia for carotid endarterectomy: Special considerations

et al. 2018

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“…Because the awake assessment method used during regional anesthesia can avoid any shunts malfunction incidence [shuntrelated stroke] that may occur in GA with routinely shunt using protocol during CEA procedures. Besides, CEA procedures using GA increases postoperative complications in those patients with myocardial issues [21].…”

Section: Anesthesiamentioning

confidence: 99%

Carotid Endarterectomy General or Regional Anesthesia

Makram

Meliegy

Amer

2019

Benha Journal of Applied Sciences

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Carotid artery disease is the result of atherosclerosis, if the obstruction of common carotid and the bifurcation of the common carotid artery or internal carotid artery occurred. The embolic phenomenon is the main cause of this obstruction. The role of collateral blood flow (circle of Willis and exracranial anastomosis channels) is very important. During endoarterctomy, the degree of ischemia and postoperative complications depends on the degree of the dependency of cerebral circulation on the ipsi lateral internal carotid artery, and the efficiency of the collateral circulation. There is five folds increase in the incidence of perioperative stroke, with the presence of good cerebral blood flow during the surgery. The aim of this study is to review the anesthetic choices between general anesthesia and regional anesthesia displaying the merits of local anesthetic methods in achieving a reduced hospital stay, patient satisfaction, and fewer complications. Carotid artery disease is defined by the narrowing or lockage of the artery due to laque build-up. The process hat blocks these arteries (atherosclerosis) are basically the same as that which causes coronary artery disease and peripheral artery disease (PAD). The slow build-up of plaque (which is a deposit of cholesterol, calcium, and other cells in the artery wall) is caused by high blood pressure, diabetes, tobacco use, high blood cholesterol and other modifiable risk factors. Carotid endarterectomy is surgery to remove fatty deposits (plaque) that are narrowing the arteries in neck. These are called the carotid arteries.

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“…Besides, CEA procedures using GA increases postoperative complications in those patients with myocardial issues. [ 9 10 ] Between 1968 and 1975, 290 patients were observed under CEA, divided into two groups one with general anesthesia and the second group with regional anesthesia; the first group consisting of 188 patients performed the CEA procedure with keeping shunt in all CEA patients. Three deaths were recorded in this category, plus some complications of motor impairment and weakness of extremities.…”

Section: Ethodologymentioning

confidence: 99%

Anesthetic considerations for carotid endarterectomy: A postgraduate educational review

Sultan

Alsubhi

2018

Anesth Essays Res

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Carotid endarterectomy (CEA) has shown a significant benefit in preventing ipsilateral stroke when it is compared to conservative management. Surgical morbidity and mortality must be kept to a minimum to achieve this benefit. Neurological status of the CEA patients can be monitored easily during regional anesthesia depending on the awake testing (neurocognitive assessment) method of the CEA patients. In addition, specific parameters can help us to monitor and to predict the neurological status of the CEA patients during the procedures such as regional cerebral oxygen saturation (rSO2) and middle cerebral artery velocity (MCAv) changes. We conducted a computerized literature search involving humans, published in English until December 2017, and indexed through Medical Databases; MEDLINE/PubMed, EMBASE, and Web of Science. We reviewed articles performed for prospective and other types of studies related to CEA procedures and techniques which can predict patient's status during the procedure. Searching relevant articles and discussing the results to allow meaningful rate comparison, and to conclude a result view which benefits the CEA patients and the medical staff during the CEA procedures. In total, studies observed cerebral rSO2 and MCAv have significant value during CEA procedures. Patients with neurological symptoms during the procedures showed changes of cerebral rSO2 and MCAv more than the patients without neurological symptoms. Mentioned parameters (cerebral rSO2 and MCAv) showed significant increasing right after the procedure. Mostly, CEA surgeries under local anesthesia were observed, for monitoring patients’ consciousness status and comparing it to patients who undergo general anesthesia, to view the reliability of these techniques during CEA procedures, and to predict and avoid intraoperative neurological symptoms.

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Examination of regional anesthesia for carotid endarterectomy

Abstract: In our practice, carotid endarterectomy under regional anesthesia is safe and associated with a very low rate of conversion to general anesthesia.

Cited by 14 publications

References 16 publications

General versus local anesthesia for carotid endarterectomy: Special considerations

General versus local anesthesia for carotid endarterectomy: Special considerations

Carotid Endarterectomy General or Regional Anesthesia

Anesthetic considerations for carotid endarterectomy: A postgraduate educational review

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