The differing effects of regional and general anaesthesia on cerebral metabolism during carotid endarterectomy

Abstract

Although GA may offer a degree of cerebral protection by reducing cerebral metabolic rate (lower falls in SJvO2 and caa3) RA preserved cerebral autoregulation as judged by the spontaneous recovery in caa3 and HbO2 levels.

General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial

“…10 However, in this study, although general anaesthesia was associated with a slightly higher risk than local anaesthesia of perioperative stroke, myocardial infarction, or death, this diff erence was not statistically signifi cant. Patients with contralateral-carotid occlusion might be an exception; their risk of stroke seemed higher during surgery under general anaesthesia than under local anaesthesia, although this was not statistically signifi cant.…”

“…Most clinical trials in various major surgical procedures have failed to show a convincing benefi t for local anaesthesia. 6,11,12 For carotid surgery, one possible benefi t of local anaesthesia could be the increase in systemic blood pressure that occurs after carotid clamping under local anaesthesia 10 and its eff ect in maintaining cerebral perfusion. Local anaesthesia could also reduce the stress response to surgery, although other factors (physical scale of surgery, size of incision, internal visceral damage, and blood loss) aff ect this response more than the type of anaesthesia.…”

The effect of peribulbar block with ropivacaine on bi‐hemispheric cerebral oxygen saturation in aged patients

“…First, the small number of patients may have hidden some true variations, but the number of patients included in each group of our study is very similar, or higher, to previous ones evaluating the modification of cerebral rSO 2 during procedures performed with regional anaesthesia [19][20][21]. Other limitations in our study are imposed by the constraints of patient safety in clinical research limiting invasive monitoring.…”

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

“…11) Other benefits of RA comprise the avoidance of expensive neurological monitoring, stable blood pressure, reduced vasopressor requirements, 12) and preserved cerebral autoregulation of perfusion. 13) Despite its advantages, RA requires patient cooperation. We generally performed CEA under RA with deep cervical block.…”