General or Local Anesthesia for Carotid Endarterectomy—The “Real-World” Experience

Abstract

Perioperative complications from carotid endarterectomy (CEA) are the main drawbacks of the procedure. The aim of this study was to assess the complication rates in patients undergoing CEA under general anesthesia (GA) or regional anesthesia (local anesthesia [LA]) at our institution. Patients undergoing CEA at our regional vascular unit between 2000 and 2004 were included. Data were collated retrospectively from a prospective database. Follow-up was up to 62 months. In all, 383 endarterectomies were performed, 260 of which were under LA. Outcome measures included 30-day death (2.1%), stroke (1.8%), and combined stroke and death (2.8%). A 30-day incidence of stroke, death, and combined stroke and death was lower in the LA group. Incidence of myocardial infarction and transient ischemic attacks, and annual mortality were higher in the LA group. No significant difference was found between the 2 groups. In a unit where CEA is preferentially performed under LA, anesthesia technique failed to significantly influence outcome.

General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis

“…Seven nonrandomized studies with one arm's sample size being at least twice as big as the other arm and which had high chances of bias were excluded. 11,12,14,25,27,28,31 The 24 remaining studies were analyzed, yielding similar results: LA was associated with shorter total surgical time (WMD À8.77 min [À16.84 to À0.69]; p = 0.03) ( Supplementary Fig 3), lower stroke rate (OR 0.64 [0.38-0.89]; p = 0.01) ( Supplementary Fig 4), cardiac complications (OR 0.48 [0.32-0.72]; p = 0.004) ( Supplementary Fig 5), 30-day mortality (OR 0.66 [0.45-0.96]; p = 0.03) ( Supplementary Fig 6), and TND rates (OR 0.58 [0.38-0.89]; p = 0.01) ( Supplementary Fig 7). Heterogeneity was significant for total surgical time (I 2 = 0.99, chisquare = 1,214.45; p < 0.00001) and cardiac complications (I 2 = 0.43, chi-square = 29.79; p = 0.03) but not for stroke (I 2 = 0.15, chi-square = 18.88; p = 0.28), TND (I 2 = 0.24, chisquare = 18.33; p = 0.19), and 30-day mortality (I 2 = 0.00, chisquare = 11.72; p = 0.86).…”

Patient Satisfaction with General versus Local Anesthesia during Carotid Endarterectomy

“…In most workplaces only one type of anesthesia is chosen according to their practice and tradition. [1][2][3][4][5] We use both anesthetic techniques at our department. The type of anesthesia is always selected individually.…”

“…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.…”

Carotid Endarterectomy: A Comparison on General and Local Anesthesia

“…Stoner et al [11] reported a significantly reduced perioperative complication rate associated with use of LA, especially in high-risk patients undergoing CEA. On the contrary, some studies found no significant differences between LA and GA in terms of stroke, death, and myocardial infarction at postoperative 30 days [12][13][14][15]. Surgical strategies including one-or two-stage operations have been suggested to minimize perioperative neurological and cardiac complications [16,17].…”