Perioperative stress response to carotid endarterectomy: The impact of anesthetic modality

Abstract

Intraoperative surgical stress was higher under LA and was blunted by carotid shunting under both LA and GA. Within 2 hours after surgery the anesthetic modality no longer had any impact on surgical trauma. The stress response to CEA, regardless of the type of anesthesia, was abolished within 24 hours. Intraoperative stress response, namely hypercortisolemia, directly correlated with subclinical and clinical cerebral hypoperfusion/ischemia during CACC. Hence, attenuation of the stress response to CEA might decrease the incidence of cerebral ischemic events.

Is cortisol the key to the pathogenesis of delirium after coronary artery bypass graft surgery?

“…Moreover, in previous studies, an association between the duration of carotid artery cross-clamping and increased cortisol level was observed, suggesting a positive correlation between cerebral hypoperfusion and excessive cortisol secretion [10]. This interesting issue should be the subject of future investigation.…”

Effect of intercostal nerve block combined with general anesthesia on the stress response in patients undergoing minimally invasive mitral valve surgery

“…Particularly when it is intense and persistent, the stress response may transform from an adaptive and protective role into a pathological phenomenon, and may even result in perioperative complications and mortality (2). Thus, a number of studies have attempted to alleviate stress damage, for example by afferent blocking of nociceptive stimulus or regulating humoral factors (3)(4)(5).…”

Ultrasound-guided regional anesthesia for carotid endarterectomy induces early hemodynamic and stress hormone changes

“…6 In contrast, data on reflex hypertension caused by locoregional anesthetics for CEA under real-life conditions in the operating room are rare. 5,7 Ultrasound (US)-guided locoregional anesthesia is a more up-to-date and advanced method for CEA allowing the directly visualized injection of LAs beneath the carotid bifurcation. 8 Hemodynamic and stress hormone changes during CEA under US-RA are unknown, and no randomized controlled trial has evaluated them compared with GA. Consequently, the aim of this study was to assess early sympathetic activity during CEA in US-RA or GA.…”