The Choice of the Type of Anesthesia for Carotid Endarterectomy (Review)

Симонов, О. В.; Тюрин, И. Н.; Прямиков, А. Д.; Миронков, А. Б.

doi:10.15360/1813-9779-2018-6-95-113

Cited by 5 publications

(2 citation statements)

References 77 publications

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“…Furthermore, some authors have reported a lower incidence of severe cardiovascular complications during the perioperative period when regional anesthesia is used compared with general anesthesia. [18][19][20]…”

Section: Discussionmentioning

confidence: 99%

Bilateral Dolichoarteriopathies of the Internal Carotid Artery: Surgical Treatment and Results

Dogalbayev,

Fursov,

Sultanaliev

et al. 2024

Int J Angiol

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The approach to surgical treatment of symptomatic bilateral dolichoarteriopathies of the internal carotid artery (DICA) remains an unresolved problem today. The aim of this article is to compare the methods of reconstruction of the stage-by-stage surgical treatment of bilateral DICA, depending on the type of deformity. The study included 30 patients with clinical manifestations of cerebrovascular insufficiency (CVI), who were found to have hemodynamically significant bilateral DICA. The patients underwent stage-by-stage operations on both sides, resulting in a total of 60 reconstructive operations on the carotid arteries. Based on the type of reconstruction, the patients were divided into three groups. All three groups showed positive dynamics with relief of the CVI clinical symptoms (p = 0.01), except for patients with persistent residual effects after strokes. Hemodynamic indices in the ICA also normalized after surgery; the linear velocity of blood flow decreased to 0.842 ± 0.087 m/s (p = 0.01) in the first group, 0.825 ± 0.057 m/s (p = 0.01) in the second group, and 0.805 ± 0.083 m/s (p = 0.01) in the third group. The results of the treatment of bilateral DICA showed that with a correctly selected approach to stage-by-stage surgical treatment, it is possible to achieve restoration of blood flow along the internal carotid artery with regression of general cerebral symptoms.

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Section: Discussionmentioning

confidence: 99%

Bilateral Dolichoarteriopathies of the Internal Carotid Artery: Surgical Treatment and Results

Dogalbayev,

Fursov,

Sultanaliev

et al. 2024

Int J Angiol

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“…В то же время к недостаткам комбинированной общей анестезии с интубацией трахеи следует отнести эпизоды значительных изменений показателей гемодинамики, прежде всего, частое развитие гипотензии после индукции в анестезию и резкий подъем артериального давления до либо после экстубации трахеи. Эти изменения могут быть причиной развития периоперационного инсульта или инфаркта, особенно у пациентов с тяжелыми сопутствующими заболеваниями сердечно-сосудистой системы, а также кровотечением из послеоперационной раны [5,6].…”

Section: обсуж дение результатовunclassified

Experience With Regional Anesthesia for Carotid Endarterectomy at the N.V. Sklifosovsky Research Institute for Emergency Medicine

Mustafayeva¹,

Zhuravel²,

Mikhailov³

et al. 2023

Neotložnaâ med. pomoŝʹ

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Acute cerebrovascular accident is one of the major causes of death and disability of patients around the world. In 30-40% of cases, the cause of ischemic stroke is an extracranial lesion of the brachiocephalic vessels. Carotid endarterectomy is the main technique for preventing cerebrovascular accident in carotid artery stenosis. General anesthesia with endotracheal intubation has been the method of choice since the widespread introduction of this type of surgical intervention into clinical practice and in most centers remains so to this day. At the same time, many authors report, that the use of general anesthesia with endotracheal intubation has limitations in a number of patients, namely, in the presence of an embologenic plaque in the operated internal carotid artery, severe coronary artery disease, decompensated aortic and / or mitral stenosis, low ejection fraction, heart rhythm and conduction disorders, severe chronic diseases of the respiratory system, as well as patient refusal for general anesthesia.THE AIM of the study was to show the possibilities of using regional anesthesia for carotid endarterectomy in a high-risk patient.RESULTS The use of regional anesthesia allows surgeons to avoid instability or abrupt changes in hemodynamics in the intraoperative period. Indications for its use are also cases of critical contralateral stenosis of the internal carotid artery when it is necessary to carefully consider the advisability of installing an internal stent.CONCLUSION The use of regional anesthesia made it possible to successfully perform carotid endarterectomy without cardiovascular events, neurological deficit and postoperative complications in a patient with relative contraindications to general anesthesia.

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Regional Anesthesia for Carotid Endarterectomy in Patients with Acute Ischemic Stroke (Pilot Study)

Симонов

Pryamikov

Loluev

et al. 2022

Obŝaâ reanimatologiâ

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Objective. The aim of this study is to assess the safety of the use of regional anesthesia for performing carotid endarterectomy (CEA) in patients in the acute phase of ischemic stroke.Material and methods. The study included 66 patients in the acute phase of ischemic stroke (atherothrom-botic subtype according to the TOAST classification) who underwent carotid endarterectomy. The inclusion criteria for the study were as follows: acute phase of atherothrombotic ischemic stroke (first 28 days), ipsilateral symptomatic ≥ 50% stenosis of the internal carotid artery, 1-4 points neurological deficit according to the modified Rankin Scale (mRS), 1-13 points neurological deficit according to the National Institutes of Health Stroke Scale (NIHSS), size of the cerebral ischemic lesion ≤ 4 cm. This single-center prospective cohort study compared two anesthetic approaches, regional anesthesia (RA, 46 patients) and general anesthesia (GA, 20 patients). The RA techniques included ultrasound-guided superficial and deep cervical plexus blocks on the side of the surgery.Results. The study found no significant differences in the baseline patient characteristics, surgery techniques and clinical outcomes between the groups. There were no neurological or cardiovascular toxic reactions to the local anesthetics. Conversions from RA to GA were not performed. In the RA group, recurrent ipsilateral ischemic strokes, myocardial infarctions, wound hemorrhagic complications and lethal outcomes did not occur.Conclusion. This pilot study has demonstrated the safety of RA for performing CEA in patients in the acute phase of ischemic stroke. RA provides adequate neuromonitoring and timely intraoperative recognition of «new» ischemic complications. To compare the efficacy of RA and GA for performing CEA in patients with acute ischemic stroke, large randomized controlled trials are needed.

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The Choice of the Type of Anesthesia for Carotid Endarterectomy (Review)

Cited by 5 publications

References 77 publications

Bilateral Dolichoarteriopathies of the Internal Carotid Artery: Surgical Treatment and Results

Bilateral Dolichoarteriopathies of the Internal Carotid Artery: Surgical Treatment and Results

Experience With Regional Anesthesia for Carotid Endarterectomy at the N.V. Sklifosovsky Research Institute for Emergency Medicine

Regional Anesthesia for Carotid Endarterectomy in Patients with Acute Ischemic Stroke (Pilot Study)

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