Regional anaesthesia techniques for carotid surgery: the state of art

Ciccozzi, Alessandra; Angeletti, Chiara; Guetti, Cristiana; Pergolizzi, Joseph V.; Angeletti, Paolo Matteo; Mariani, Roberta; Marinangeli, Franco

doi:10.1007/s40477-014-0094-5

Cited by 13 publications

(40 citation statements)

References 69 publications

(71 reference statements)

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“…The absence of a study of ultrasound guided deep cervical block in CEA may lead the way for further studies. (1)(2)(3)(4)(5) 0.396 VAS, visual analog scale Scores were assessed with a horizontal VAS consisting of a line going from left (score 0; no pain) to right (score 10; maximal pain). Patient and surgeon satisfaction scores were measured on a 5-point scale (1, very satisfied; 2, satisfied; 3, average; 4, poor; and 5, very poor).…”

Section: Limitationsmentioning

confidence: 99%

“…This may be performed by using superficial cervical plexus block (CBP), intermediate CPB, deep CPB or combined (deep plus superficial) CPB. 1 Deep CPB has been associated with a variety of complications such as injection of local anaesthetic (LA) into the vertebral artery, intratechal injection, and respiratory failure/distress. 2 Intermediate CPB refers to an injection of LA in the space between the superficial and deep cervical fasciae.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Combined (Deep and Superficial) and Intermediate Cervical Plexus Block by Use of Ultrasound Guidance for Carotid Endarterectomy

Kavakli

Öztürk

Ayoglu

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Combined (Deep and Superficial) and Intermediate Cervical Plexus Block by Use of Ultrasound Guidance for Carotid Endarterectomy

Kavakli

Öztürk

Ayoglu

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

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“…A shunt was selectively used in case of neurologic deterioration at cross-clamping test at duration of 2-3 minutes. (16,17,20) A standard incision parallel to the sternocleidomastoid muscle was performed and common carotid artery, internal carotid artery, and external carotid artery were prepared and dissected. After administrationof 5000 IU heparin intravenously, the arteries were clamped.…”

Section: Surgical Techniquementioning

confidence: 99%

Carotid Endarterectomy in Awake Patient: Review Article

Erdinç¹

2019

ejcm

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Cardiac mortality and morbidity in patients undergoing carotid surgery is between 0.7% and 7.1%. Although surgical techniques used in carotid surgery varies, there are differences in anesthesia techniques and the results are different. The advantages and disadvantages of anesthesia techniques are discussed in several studies and various results have been obtained. These different results involve the acquisition or loss of anesthesia technique, even if the patient group is the same. Carotid surgery under loco/regional anaesthesia may be thought easy. Although the complex structure of the head and neck region takes difficulty of during surgery, direct cerebral monitorization in the awake patient increases the success rate of the surgery. In this review we will explain the carotid endarterectomy management in the awake patient.

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“…In addition there is less respiratory depression and the patient wakes up easily with verbal stimuli and may cooperate for neurological assessment. Although dexmedetomidine can theoretically decrease cerebral blood flow by inducing some degree of vasoconstriction in the brain, evidence suggests that is safe and effective in this context [74][75][76].…”

Section: Dexmedetomidinementioning

confidence: 99%

Carotid Stenosis and Anaesthesia

Jj¹,

A²,

Jl³

et al. 2016

Int J Surg Surgical Proced

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EpidemiologyThe importance of carotid stenosis approach lies in the relationship it has with ischemic stroke, since it is present in 10-20% of all of them. This is of magnitude when we know that in Western countries, stroke is the third leading cause of death, behind only heart disease and cancer, with a mortality ranging from 10 to 30%, having survivors risk of recurring ischemic cardiac or neurologic events, so much so that is the leading cause of disability. The prevalence of stenosis in the internal carotid artery (ICA) is high and furthermore increases with age, in fact more than 50% stenosis rises from 0.5% in people aged between 50 and 59 years to 10% in those over 80 years. The primary mechanism involved in stroke in patients with carotid stenosis is embolism of atherosclerotic or thrombotic waste material from the plate to the distal cerebral vasculature. Infiltration of inflammatory cells on the surface of carotid plaques can play a key role in causing plaque rupture and embolization or occlusion of the carotid and also hemodynamic factors are correlated with increased risk of stroke in patients with carotid stenosis [1,2,3]. Of all the factors studied, the degree of arterial stenosis has emerged as the most directly related to the increased risk of stroke. Any diagnostic strategy, whatever the technique used, should have as its primary objective to determine, in the most accurate way, the amount of this stenosis [4].In the NASCET study the risk of ipsilateral recurrent stroke in patients with symptomatic carotid stenosis treated conservatively was 4.4% per year for patients with stenosis between 50 and 69% and 13% per year for those with 70% stenosis. The risk in patients with asymptomatic stenosis of 60% was around 1-2%, but could rise to 3-4% per year in elderly patients or in the presence of stenosis or occlusion of the contralateral artery, evidence of silent embolization in an imaging test, heterogeneity of the carotid plaque, poor collateral circulation, generalized inflammatory state or peripheral or coronary artery disease associated [5]. Treatment Medical versus interventional treatmentGiven the above discussion, we will assume that the main objective in the treatment of carotid stenosis is the prevention of ischemic stroke and its aftermath, regardless of the type of patient, the presence or absence of symptoms and the degree of stenosis. However, despite the clarity of the target it is unclear what therapeutic option to choose among only medical treatment or revascularization and, in the latter case, between endoluminal or surgical treatment. We will be guided in this review [6], considering that these guidelines place more emphasis on stroke prevention in the prevention of ischemic heart disease, on the grounds that according to the CREST study, stroke has shown greater impact on quality of life of the patient than nonfatal myocardial ischemia [7].The major determinants of the clinical course are the presence or absence of neurological symptoms and the degree of stenosis. The threat of isc...

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Regional anaesthesia techniques for carotid surgery: the state of art

Cited by 13 publications

References 69 publications

Comparison of Combined (Deep and Superficial) and Intermediate Cervical Plexus Block by Use of Ultrasound Guidance for Carotid Endarterectomy

Comparison of Combined (Deep and Superficial) and Intermediate Cervical Plexus Block by Use of Ultrasound Guidance for Carotid Endarterectomy

Carotid Endarterectomy in Awake Patient: Review Article

Carotid Stenosis and Anaesthesia

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