Regional Anaesthesia for Carotid Endarterectomy

Stoneham, M. D.; Stamou, Despoina; Mason, Justin

doi:10.1097/sa.0000000000000154

Cited by 8 publications

(16 citation statements)

References 76 publications

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“…In einigen Fällen erfolgt zwischen Indexereignis und CEA bei symptomatischen Patienten eine duale Plättchenhemmung (ASS, Clopidogrel) zur Verminderung eines erneuten zerebralen ischämischen Ereignisses. Die Fortführung dieser dualen Therapie bis zur CEA sollte bei eingeschränkter Evidenz unter interdisziplinärer, strenger Risiko-Nutzen-Abwägung erfolgen 3 , 16 . Die risikoadaptierte Überbrückung mit niedermolekularem Heparin kann eine Alternative zur Fortführung einer oralen Antikoagulation bieten.…”

Section: Perioperative Medikationunclassified

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Anästhesie und perioperatives Management der Karotis-Endarteriektomie (CEA)

Gaik¹,

Wiesmann²

2022

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungDie Karotis-Endarteriektomie ist eine Standardoperation zur Therapie und Prophylaxe von ischämischen Schlaganfällen bei bestimmten Patientenkollektiven. Für eine optimale perioperative anästhesiologische Versorgung sind grundlegende Kenntnisse der Anatomie, Pathophysiologie sowie der OP-Technik notwendig. Mit der Allgemein- und der Regionalanästhesie stehen 2 verschiedene Anästhesieoptionen zur Wahl. Der Leser soll bei der Lektüre des Beitrags ein tiefergehendes Verständnis für die Erkrankung, die Operation und das daraus resultierende perioperative anästhesiologische Management erhalten.

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Section: Perioperative Medikationunclassified

“…Bei Patienten mit Diabetes mellitus ist vor einer CEA die strikte Kontrolle des Blutzuckers (Erstellung eines Tagesprofils, Zielwert < 180 mg/dl, < 10 mmol/l) empfehlenswert 3 , 16 .…”

Section: Perioperative Medikationunclassified

Anästhesie und perioperatives Management der Karotis-Endarteriektomie (CEA)

Gaik¹,

Wiesmann²

2022

Anästhesiol Intensivmed Notfallmed Schmerzther

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“…Post-clamping neurological deficits (ND) were defined as any alteration in the neurologic examination during CACC (mostly dysphasia, contralateral hemiparesis, and change in cognitive/consciousness status) persistent after hemodynamic adjustment [16].…”

Section: Definitionsmentioning

confidence: 99%

Efficacy of near-infrared spectroscopy cerebral oximetry on detection of critical cerebral perfusion during carotid endarterectomy under regional anesthesia

Rocha‐Neves

Pereira-Macedo

Moreira

et al. 2020

Vasa

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Summary: Background: Patients undergoing carotid endarterectomy (CEA) may suffer from cerebral hypoperfusion during the carotid cross-clamping. Near-infrared spectroscopy cerebral oximetry (NIRS) is a non-invasive method of regional cerebral oxygen saturation measurement reflecting changes in cerebral blood flow during CEA. The main goal of the study was to evaluate the accuracy of the NIRS in detecting cerebral hypoperfusion during CEA under regional anesthesia (RA) and compare it with awake neurological testing. Patients and methods: A prospective observational study of 28 patients that underwent CEA in RA and manifested neurologic deficits, and 28 consecutive controls from a tertiary and referral center, was performed. All patients were monitored with NIRS cerebral oximetry and awake testing as the control technique. Subsequently, operating characteristic curve and Cohen’s kappa coefficient were determined to evaluate the reliability of the monitoring test. Results: NIRS presented a sensitivity of 27.3% and a specificity of 89.3% in comparison to awake testing. Receiver operating characteristic (ROC) curve analysis demonstrated that a decrease of at least 20% in cerebral oxygen saturation is the best threshold to infer cerebral hypoperfusion. However, the respective area under the curve (AUROC) was 0.606 (95% CI: 0.456–0.756, P = 0.178) with a calculated Cohen’s kappa of 0.179, P = 0.093. Regarding 30-days outcomes, only awake testing has shown significant associations with stroke and postoperative complications ( P = 0.043 and P = 0.05), which were higher in patients with post-clamping neurologic deficits. Conclusions: NIRS demonstrated a reduced discriminative capacity for critical cerebral hypoperfusion, and does not seem to add substantial clinical benefits to the awake test.

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“…Cervical block anesthesia (CBA) has evolved over the last 20 years with novel methods of locating the cervical plexus and innovative drugs. [82][83][84] In patients with significant cardiopulmonary comorbidities or when GA is contraindicated, LA many be a safer option. The disadvantages of LA include risk of seizure or allergic reaction, discomfort for the patients undergoing surgery and distraction to the attending surgeon.…”

Section: Local Anesthesiamentioning

confidence: 99%

Carotid endarterectomy has significantly lower risk in the last two decades: should the guidelines now be updated?

Radak¹,

Waard²,

Halliday³

et al. 2018

J Cardiovasc Surg

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Carotid endarterectomy (CEA) carries a significant risk of procedural stroke and death Guidelines recommend keeping this risk below 6% and below 3% for symptomatic and asymptomatic patients respectively. After analysing our Institute's CEA results during the past 25 years, we found the rate of postoperative complications was now well below Guideline thresholds. Accordingly, we studied temporal changes in procedural risks in randomized controlled trials (RCTs) and in large observational studies in order to compare these against Guidelines. We found a clear temporal trend towards improving procedural outcomes, which can be explained by improvements in medical therapy, more appropriate timing of CEA, the use of local anaesthesia and the use of peroperative cerebral monitoring as well as improving surgical techniques. An update of current guidelines should now be undertaken, since our findings are not unique and are supported by other studies in this review.

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Regional Anaesthesia for Carotid Endarterectomy

Cited by 8 publications

References 76 publications

Anästhesie und perioperatives Management der Karotis-Endarteriektomie (CEA)

Anästhesie und perioperatives Management der Karotis-Endarteriektomie (CEA)

Efficacy of near-infrared spectroscopy cerebral oximetry on detection of critical cerebral perfusion during carotid endarterectomy under regional anesthesia

Carotid endarterectomy has significantly lower risk in the last two decades: should the guidelines now be updated?

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