Hemodynamic benefits of regional anesthesia for carotid endarterectomy

Abstract

CEA performed with CB is associated with significantly less perioperative hemodynamic instability than with GA. This results in fewer major adverse cardiac events. Ultimately, decreased critical care resource use is realized as is a shortened length of stay.

Endarterectomia de carótida em paciente acordado

“…The occlusion time of the carotid was similar to the other works [4,17] and the total time of surgery was less in comparison to CAE performed under GA in the past in our service, also similar to works by other authors [11,13,14]. The mean time of ICU stay was 1.34 days and the trend is not to routinely refer patients to the ICU, but to carefully monitor them in the recovery room and transfer them to the ICU only when hemodynamically unstable [3,11].…”

“…The mean time of ICU stay was 1.34 days and the trend is not to routinely refer patients to the ICU, but to carefully monitor them in the recovery room and transfer them to the ICU only when hemodynamically unstable [3,11]. The mean time of hospitalization was also short of around 4 days, comparable to other publications [13,14,17]. These results added to a reduction in the use of intravenous antihypertensive medications and the utilization of shunts, also giving a reduction in costs [11,14].…”

“…Bowyer et al [14] noted significantly greater incidences of strokes with GA compared to RA [5.3% versus 1.1%]. Sternbach et al [13] discovered similar neurological morbidities in both groups, but with lower rates of AMI, congestive heart failure and ventricular arrhythmia in patients who were submitted to RA. Patients who underwent CAE are frequently elderly with numerous comorbidities.…”

“…In studies that evaluated the physiological advantages of CAE with RA to the cerebral blood flow showed lower rates of intra-operative hypertension in relation to surgery with GA (8% versus 40%) [11], more hemodynamical instability and a greater necessity of the administration of vasoactive medications in the intra-and post-operative periods in the GA group [13,14]. In this study, it was also observed that 83% of the patients operated on with GA and 75% of patients who were submitted to RA and who had post-operative complications had presented with severe peri-operative hypertension [14].…”

“…The parameters evaluated in this study were selected with the aim of verifying some of the possible advantages of CAE with regional anesthesia (RA) when compared to GA, as previously reported by several authors. These include more efficient neurological monitoring, reduction in the necessity of intra-operative shunts, lower risks associated to the GA in a high-risk population, greater stability of the arterial pressure with less use of endovenous anti-hypertensive therapy, shorter surgery times, shorter ICU stays, earlier release from hospital and lower rates of peri-operative strokes and cardiovascular complications [4,5,[10][11][12][13][14].…”