Regional Anesthesia with Dexmedetomidine Infusion: A Feasible Method for the Awake Test during Carotid Endarterectomy

Lee, Jonggeun; Song, Seunghwan; Chung, Sung Woon; Sung, Sang Min; Cho, Han Jin

doi:10.3400/avd.oa.16-00049

Cited by 11 publications

(27 citation statements)

References 22 publications

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“…• GA necessitates shunt insertion more commonly than RA techniques (14,15,23,27) • Requires brain monitoring (stump pressure, somatosensory evoked potential, transcranial Doppler, electroencephalogram and near-infrared spectroscopy, juguler venous oxygen,cerebral oximetry) (3,7,9,24,30) . These methods shows poor sensitivity and specificity according to awake patient, in terms of requirement for shunt placement (15,24) • Anaesthetic-induced circulatuar depression is associated with labile blood pressure (3) and necessitates greater vasopressor support (To ensure adequate cerebral perfusion pressure during carotid cross-clemping) (14,15,25,26,) • Higher incidence in postoperative neurocognitive dysfunction (15,17) Advantages of regional anesthesia are:…”

Section: Surgical Techniquementioning

confidence: 99%

“…• Awake patient is the gold standart cerebral function monitoring (14,15,17,20,21) • Reduce cardiac and respiratory related morbidity (15,16,18,20) • Lower shunt insertion rate (14,15,17,19,21,24) • Shorten hospital stay (14,15,17,19,21,24) • Lower cost (14,15,18,21) • Improves outcomes after surgery (better postoperative analgesia, reduce blood loss, lower risk of tromboembolic events) (15,18,20,22) • Safer (14) • Safe method to identify the patients at risk for crossclamp intolerance (1,3,12) • Hemodynamic stability (14,17,18,21,22,24,27) • Preserved cerebral autoregulation (14,16,18,24,25) • Reduce vasopressor requirement (25) • Reduces operative time (24) Disadvantages of regional anest...…”

Section: Surgical Techniquementioning

confidence: 99%

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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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Section: Surgical Techniquementioning

confidence: 99%

Section: Surgical Techniquementioning

confidence: 99%

Carotid Endarterectomy in Awake Patient: Review Article

Erdinç¹

2019

ejcm

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“…Острое появление гемипареза на контралатеральной вмешательству стороне или афазии при левосторонних вмешательствах у правшей на этапе кросс-клампинга ВСА наглядно свидетельствует о неадекватности коллатерального мозгового кровотока и требует незамедлительной коррекции в виде установки временного внутрипросветного шунта и/или повышения системного АД. У обоих подходов (общая или локорегионарная анестезия) есть свои сторонники и противники, а спор между ними продолжается до сих пор [53][54][55][56][57][58][59][60][61]. Определенные надежды возлагались на проведенный на базе, главным образом, европейских клиник GALA трайл, направленный на сравнение ближайших и отдаленных результатов каротидной эндартерэктомии, проводимой в условиях общей или регионарной анестезии.…”

Section: реконструктивная хирургия сонных артерийunclassified

Neurosurgery in conscious patients: forward to the past

Lubnin

2018

Vopr. neirokhir.

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We present an analytical review of various neurosurgical interventions in conscious patients. An analysis of the literature indicates growing interest in this problem. Craniotomy in conscious patients has been extensively used in resection of space-occupying cerebral lesions in the eloquent hemispheric areas and in epilepsy surgery. In recent years, there have been a number of reports on interventions in conscious patients with other neurosurgical pathologies, which may be regarded as a new emerging tendency in neurosurgery and neuroanesthesiology. Neurosurgery in conscious patients provides a special advantage because it enables highly functional neuromonitoring without use of complex devices.

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“…The awake test under regional anesthesia is the most reliable method among all techniques of cerebral perfusion monitoring (2). However, different methods are used to monitor cerebral perfusion such as Transcranial doppler (TCD) and Near-Infrared Spectroscopy (NIRS) which have come into prominence in recent years (3).…”

Section: Introductionmentioning

confidence: 99%

The effect of normotensive arterial pressure on cerebral saturation during carotid endarterectomy

Yücel¹,

Kayalar²

2021

Journal of Health Sciences and Medicine

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Aim: Monitoring of cerebral perfusion during carotid endarterectomy helps to institute early intervention to prevent risk of ischemia during the operation. We aimed to evaluate if the disadvantages of high systemic pressure can be avoided by keeping arterial blood pressure below 150 mmHg during cross-clamping of the internal carotid artery by correlating our findings of NIRS values with clinical results. Material and Method: This was designed as a prospective study that included elective patients scheduled for an operation of carotid artery stenosis under general anesthesia. A total of 60 patients operated on between August and October 2019 were included in the study. Results: Patients' NIRS findings on the right and left hemispheres were analyzed separately to be able to differentiate any possible changes of NIRS of the cerebral hemisphere ipsilateral to the clamped carotid artery. The analysis of the right and left NIRS findings in these 60 patients revealed a significant decrease between intubation and incision NIRS values (p=0.008 and p=0.02 respectively). Conclusion:Considering the NIRS findings and clinical observations of the patients in the postoperative period, we think that ICA endarterectomy operations may be safe to perform in a suitable patient group while the systolic arterial blood pressure is maintained below 150mmHg during cross-clamping.

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Regional Anesthesia with Dexmedetomidine Infusion: A Feasible Method for the Awake Test during Carotid Endarterectomy

Cited by 11 publications

References 22 publications

Carotid Endarterectomy in Awake Patient: Review Article

Carotid Endarterectomy in Awake Patient: Review Article

Neurosurgery in conscious patients: forward to the past

The effect of normotensive arterial pressure on cerebral saturation during carotid endarterectomy

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