Perioperative outcome of carotid endarterectomy with regional anesthesia: two decades of experience from the Caribbean

Subramanian, Hariharan; Naraynsingh, Vijay; Esack, Azad; Ramdass, Michael J.; Teelucksingh, S; Naraynsingh, Aroon

doi:10.1016/j.jclinane.2009.05.005

Cited by 8 publications

(5 citation statements)

References 24 publications

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“…It only provides analgesia, not paralyze the muscles (9,10,14) . According to Hariharan et al experience, when SCPB is used alone, there is an increased need for supplementation of LA infiltration, especially during the dissection of the distal portion of ICA (43) .…”

Section: A Superficial Cervical Plexus Block (Scpb)mentioning

confidence: 99%

Anesthesia Management for Carotid Endarterectomy: Review Article

Yilmaz¹

2019

ejcm

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Atherosclerotic carotid artery disease is responsible from 20% to 25% of ischemic stroke events. Open carotid surgery and stent insertion are two main types of treatment procedures. Carotid endarterectomy (CEA) can be performed under general anaesthesia, regional anaesthesia (interscalen block, cervical plexus block either by landmark technique or by US guidance), combination of general and regional anaesthesia, regional anaesthesia with combination of periferic block. The aim of all anesthesic techniques is to prevent pain during the three painful periods (1. Skin incision, 2. Insertion of a retromandibular retractor, 3. Perivascular preparation) during CEA). All techniques have their own advantages and disadvantages. But there is no certain data about which one is superior to other. There is no consensus on anaesthetic choice for CEA. At present regional anaesthesia versus general anaesthesia for patients undergoing CEA is still debate topic. Improvements in medical theraphy, use of cerebral monitoring, better timing for surgery after ischemic events, better surgical techniques, increased use of ultrasound for regional anaesthesia improve procedural outcomes. Despite these improvements, anaesthesia management is still deciding according to surgeon and anaesthesiologist preferences, the patient's satisfaction and the conditions in the hospitals where we work.

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Section: A Superficial Cervical Plexus Block (Scpb)mentioning

confidence: 99%

Anesthesia Management for Carotid Endarterectomy: Review Article

Yilmaz¹

2019

ejcm

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“…In a previous series, if we had to convert the patient to general anaesthesia during carotid endarterectomy, we would first test clamp the common carotid in the awake patient. If clamping was tolerated after 3 minutes of clamping with no neurologic deficit, we would proceed to general anesthesia and surgery without shunting with good results [5]. Based on this observation we thought that we might be able to predict the need for shunting by preoperative digital compression of the common carotid.…”

Section: Discussionmentioning

confidence: 99%

“…In general, the need for shunting during CEA performed under loco-regional anesthesia ranges from 2-10% [4, 5, 7, 9]. Thus, it would appear unnecessary to do the procedure under GA with routine shunting or with special monitoring such as EEG, SSEP or stump pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Several monitoring methods have been described to define which patients need shunting such as electro-encephalographic (EEG) monitoring, internal carotid artery back pressure, somatosenory evoked potentials (SSEP) and neurologic assessment while operating under local anesthesia [1-4]. We had noted in a previous study that common carotid clamping under local anesthetic accurately predicted the need for non-shunting on conversion to general anesthesia [5]. Thus, we prospectively attempted to assess the need for shunting by preoperative digital compression of the proximal common carotid artery and correlated these findings with intraoperative assessment while performing CEA under local anaesthesia.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Digital Carotid Compression as a Predictor of the Need for Shunting During Carotid Endarterectomy

Naraynsingh

Harnarayan

Maharaj

et al. 2013

TOCMJ

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This study prospectively attempted to assess the need for shunting by preoperative digital compression of the proximal common carotid artery and correlated these findings with intraoperative assessment while performing carotid endarterectomy under local anaesthesia. Preoperative digital compression is highly predictive of the need for shunting intra-operatively and can be used as a valuable test in carefully chosen patients. This may help in decreasing the need for advanced neurological monitoring during carotid endarterectomy.

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“…Hariharan obtained a good perioperative CEA outcome under RA in a setting of developing countries with limited resources for intraoperative neurological monitoring [13].…”

Section: Introductionmentioning

confidence: 99%