Regional Versus General Anesthesia for Carotid Endarterectomy: Do We Need Another Randomized Trial?

Lomivorotov, Vladimir V.; Shmyrev, Vladimir; Непомнящих, В. А.

doi:10.1053/j.jvca.2018.09.007

Cited by 8 publications

(5 citation statements)

References 10 publications

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“…Karotis arter hastalığına bağlı inme sıklığı tüm dünyada giderek artan oranlarda tespit edilmektedir (1). Morbidite ve mortalite açısından değerlendirildiğinde ise kardiyovasküler hastalıklar içerisinde koroner arter hastalıklarından sonra ikinci sırada yer almaktadır (2,3). Karotis stenozu tedavisi için seçilecek yöntem açısından gerek plak yapısı gerekse karşı tarafın durumuna göre karar verilse de semptomatik olma ayrımına bakılmaksızın karotis arter hastalığında altın standart tedavi karotis endarterektomidir (4,5).…”

Section: Introductionunclassified

“…Rejyonel anestezi altında karotis endarterektomi cerrahisi uygulanması ile; entübasyon ortadan kalktığı için hastanın mekanik ventilasyona bağlı pnömoni riski ve özellikle KOAH gibi obstrüktif akciğer hastalığı olanlarda oluşabilecek riskler de ortadan kalkmaktadır (3). Karotis hastalığı olan bireylerde koroner arter hastalığı eşlik edebilmektedir; çalışmalarda rejyonel anestezi uygulanması ile daha az miyokard enfarktüsü gelişebileceği gösterilmiştir (10,11).…”

Section: Introductionunclassified

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Our results of carotid endarterectomy under cervical block: a first application in an Anatolian medical center

Beyaz¹,

Urfalı²,

KAYA³

et al. 2022

Mustafa Kemal Üniversitesi Tıp Dergisi

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Amaç: Karotis endarterektomi operasyonu genel anestezi ile uygulanabildiği gibi, bölgesel uygulanabilen; servikal rejyonel blok, lokal-rejyonel kombine anestezi ya da lokal infiltrasyon anestezisi altında yapılabilir. Bu çalışmada rejyonel blok uygulaması ile karotis endarterektomi uygulama deneyimlerimizi sunmayı amaçlıyoruz. Yöntem: Eylül 2020- Ocak 2022 tarihleri arasında karotis arterine endarterektomi operasyonu yapılan 61 hastanın cerrahi sonrası 30 gün süreyle erken dönem sonuçları retrospektif irdelenmiştir. Hastalara ait yaş, cinsiyet, risk faktörleri, şant kullanımı, operasyon süresi, nörolojik olaylar, mortalite ve morbidite değerlendirilmiştir. Bulgular: Toplam 61 hastanın verileri retrospektif olarak incelenmiştir. Hastalardan 15’i kadın, 46’sı erkekti. Ortalama yaş 61.6±9.1 (48-88) yıl olarak hesaplandı. Semptomatik hasta sayısı 51 idi. 10 hasta asemptomatik olup stenoz derecesi %70’in üzerindeydi. 11 hastada her iki tarafa endarterektomi uygulandı. Toplam olarak 72 karotis endarterektomi operasyonu gerçekleştirildi. Ortalama işlem süresi 77.6±19.7 dakika, karotis klemp süresi 29.4±11.5 dakika olarak hesaplandı. Taburcu edilen hiçbir hastada postoperatif ilk ay içinde majör nörolojik olay, kanama, enfeksiyon ya da ölüm ile karşılaşılmadı. Sonuç: Karotis endarterektomi operasyonu artan tecrübe ile birlikte rejyonel servikal blok altında güvenle gerçekleştirilebilir.

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Section: Introductionunclassified

Our results of carotid endarterectomy under cervical block: a first application in an Anatolian medical center

Beyaz¹,

Urfalı²,

KAYA³

et al. 2022

Mustafa Kemal Üniversitesi Tıp Dergisi

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“…A multicenter, randomized clinical trial (RCT) included 3526 operations in 3526 symptomatic and asymptomatic patients and compared PA with GA and concluded that there was no significant difference between the two techniques for stroke (including retinal infarction), myocardial infarction, and death between randomization and 30 days after surgery [ 12 ]. However, the observed difference or lack of difference may or may not be affected by several confounding factors and/or differential use of co-interventions, such as the use of different surgical techniques, selective use of shunting, and variations in materials used for patching [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

Plexus anesthesia versus general anesthesia for carotid endarterectomy: A systematic review with meta-analyses

Marsman

Wetterslev

Keus

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction Traditional carotid endarterectomy is considered to be the standard technique for prevention of a new stroke in patients with a symptomatic carotid stenosis. Use of plexus anesthesia or general anesthesia in traditional carotid endarterectomy is, to date, not unequivocally proven to be superior to one other. A systematic review was needed for evaluation of benefits and harms to determine which technique, plexus anesthesia or general anesthesia is more effective for traditional carotid endarterectomy in patients with symptomatic carotid stenosis. Methods The review was conducted according to our protocol following the recommendations of Cochrane and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Searches were updated on the October 1, 2020. We did not find any randomized clinical trial comparing plexus anesthesia and general anesthesia in carotid endarterectomy with patch angioplasty matching our protocol criteria in patients with a symptomatic and significant (≥50%) carotid stenosis. Conclusions Based on the current, high risk of bias evidence, we concluded there is a need for new randomized clinical trials with overall low risk of bias comparing plexus anesthesia with general anesthesia in carotid endarterectomy with patch closure of the arterial wall in patients with a symptomatic and significant (≥50%) stenosis of the internal carotid artery. Protocol unique identification number (UIN): CRD42019139913, ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=139913 );

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“…Carotid endarterectomy (CEA) can be performed under general anesthesia (GA) and regional anesthesia (RA) [1,2]. Although RA has approved many advantages over GA for CEA [1,3,4], there is still a debate on which one should be preferred in terms of safety and the optimal anesthetic management [2,4].…”

Section: Introductionmentioning

confidence: 99%

Carotid Endarterectomy Under Carotid Sheath Block Combined with Superficial Cervical Plexus Block by Ultrasound Guidance

2021

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Awake surgery" is considered as the gold standard for carotid endarterectomy. Hereby, we report the efficacy and the safety of "ultrasound-guided carotid sheath block combined with superficial cervical plexus block technique" for carotid endarterectomy. Even we successfully showed this technique in our study, further studies are necessary to evaluate the effectiveness of carotid sheath block for carotid endarterectomy with or without combinations of cervical plexus block and to determine the optimum dose of local anesthetic for a successful carotid sheath block.

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Regional Versus General Anesthesia for Carotid Endarterectomy: Do We Need Another Randomized Trial?

Cited by 8 publications

References 10 publications

Our results of carotid endarterectomy under cervical block: a first application in an Anatolian medical center

Our results of carotid endarterectomy under cervical block: a first application in an Anatolian medical center

Plexus anesthesia versus general anesthesia for carotid endarterectomy: A systematic review with meta-analyses

Carotid Endarterectomy Under Carotid Sheath Block Combined with Superficial Cervical Plexus Block by Ultrasound Guidance

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