Ultrasound-guided regional anesthesia for carotid endarterectomy induces early hemodynamic and stress hormone changes

Hoefer, Judith; Pierer, Eve; Rantner, Barbara; Stadlbauer, Karl-Heinz; Fraedrich, Gustav; Fritz, Josef; Kleinsasser, Axel; Velik‐Salchner, Corinna

doi:10.1016/j.jvs.2015.02.036

Cited by 15 publications

(14 citation statements)

References 22 publications

(23 reference statements)

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“…Local anesthesia inhibits carotid sinus nerve fibers beneath the carotid bifurcation and decreases baroreceptor sensitivity, leading to increased intraoperative sympathetic activity [22]. Additionally, the stressful, awake state and absence of GA-related cardiovascular depression might increase the incidence of hypertension and tachycardia [23]. However, except at T1, only 25.9% of patients who underwent RA required intervention for hypertension and tachycardia in our study.…”

Section: Discussionmentioning

confidence: 86%

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study

Cho

Kim

et al. 2018

Yeungnam Univ J Med

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BackgroundCarotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA.MethodsMedical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay.ResultsThere was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p<0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p<0.0001 between 0-6 h, p<0.004 between 6-12 h, and p<0.001 between 12-24 h). The duration of hospital stay was significantly more in the GA group (13.3±4.6 days in the GA group vs. 8.5±2.4 days in the RA group, p<0.001).ConclusionIn this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

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Section: Discussionmentioning

confidence: 86%

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study

Cho

Kim

et al. 2018

Yeungnam Univ J Med

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“…Hoefer et al assessed early sympathetic activity during CEA in ultrason guidedintermediate cervical plexus block with GA. Although, United States-Information and Communications Policy Bureau (US-ICPB) is a feasible, effective and safe form of RA for CEA; it induces temporary intraoperative hypertension and increase the stress hormone levels (26) .…”

Section: Introductionmentioning

confidence: 99%

Anesthesia Management for Carotid Endarterectomy: Review Article

Yilmaz¹

2019

ejcm

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Atherosclerotic carotid artery disease is responsible from 20% to 25% of ischemic stroke events. Open carotid surgery and stent insertion are two main types of treatment procedures. Carotid endarterectomy (CEA) can be performed under general anaesthesia, regional anaesthesia (interscalen block, cervical plexus block either by landmark technique or by US guidance), combination of general and regional anaesthesia, regional anaesthesia with combination of periferic block. The aim of all anesthesic techniques is to prevent pain during the three painful periods (1. Skin incision, 2. Insertion of a retromandibular retractor, 3. Perivascular preparation) during CEA). All techniques have their own advantages and disadvantages. But there is no certain data about which one is superior to other. There is no consensus on anaesthetic choice for CEA. At present regional anaesthesia versus general anaesthesia for patients undergoing CEA is still debate topic. Improvements in medical theraphy, use of cerebral monitoring, better timing for surgery after ischemic events, better surgical techniques, increased use of ultrasound for regional anaesthesia improve procedural outcomes. Despite these improvements, anaesthesia management is still deciding according to surgeon and anaesthesiologist preferences, the patient's satisfaction and the conditions in the hospitals where we work.

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“…In our opinion, an important reason for the high rate of local anesthetic supplementation is the complex innervations of the neurovascular sheath by the vagal and glossopharyngeal nerve. In several previous studies, ultrasound guided perivascular infiltration of the ICA decreased the necessity of local anesthetic supplementation by surgeons and increased the efficacy of regional anesthesia [8, 17, 18]. However, the influence of perivascular infiltration on local anesthetic plasma concentration or the risk of phrenic nerve paralysis were not compared so far.…”

Section: Discussionmentioning

confidence: 99%

Effects of regional anesthesia techniques on local anesthetic plasma levels and complications in carotid surgery: a randomized controlled pilot trial

et al. 2019

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BackgroundThe ultrasound guided intermediate cervical plexus block with perivascular infiltration of the internal carotid artery (PVB) is a new technique for regional anesthesia in carotid endarterectomy (CEA). We conducted a pilot study investigating the effects of deep cervical block (DCB), intermediate cervical block alone (ICB) and PVB on perioperative complications in patients undergoing elective CEA. We hypothesized, that the ropivacaine plasma concentration is higher in patients receiving DCB compared to PVB and ICB.MethodsIn a randomized controlled pilot study thirty patients scheduled for elective CEA were randomly assigned into three groups: DCB receiving 20 mL ropivacaine 0.5% (n = 10), ICB receiving 20 mL ropivacaine 0.5% (n = 10) and PVB receiving 20 mL ropivacaine 0.5% and 10 mL ropivacaine 0,3% (n = 10). As primary outcome, plasma levels of ropivacaine were measured with high performance liquid chromatography before, 5, 10, 20, 60, and 180 min after the injection of ropivacaine. Secondary outcomes were vascular and neurological complications as well as patients’ and surgeons’ satisfaction. All analyses were performed on an intention-to-treat basis. Statistical significance was accepted at p < 0.05.ResultsNo conversion to general anesthesia was necessary and we observed no signs of local anesthetic intoxication or accidental vascular puncture. Plasma concentration of ropivacaine was significantly higher in the DCB group compared to PVB and ICB (p < 0.001) and in the PVB group compared to ICB (p = 0.008). Surgeons’ satisfaction was higher in the PVB group compared to ICB (p = 0.003) and patients’ satisfaction was higher in the PVB group compared to ICB (p = 0.010) and DCB group (p = 0.029). Phrenic nerve paralysis was observed frequently in the DCB group (p < 0.05). None of these patients with hemi-diaphragmatic paralysis showed signs of respiratory distress.ConclusionThe ultrasound guided PVB is a safe and effective technique for CEA which is associated with lower plasma levels of local anesthetic than the standard DCB. Considering the low rate of complications in all types of regional anesthesia for CEA, larger randomized controlled trials are warranted to assess potential side effects among the blocks.Trial registrationThe trial was registered at German Clinical Trials Register (DRKS) on 04/05/2019 (DRKS00016705, retrospectively registered).

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Ultrasound-guided regional anesthesia for carotid endarterectomy induces early hemodynamic and stress hormone changes

Cited by 15 publications

References 22 publications

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study

Anesthesia Management for Carotid Endarterectomy: Review Article

Effects of regional anesthesia techniques on local anesthetic plasma levels and complications in carotid surgery: a randomized controlled pilot trial

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