The efficacy of carotid endarterectomy CEA in preventing the stroke in patients with symptomatic and asymptomatic carotid stenosis has been established in different multicentre randomised controlled trials. CEA under local anaesthesia versus general anaesthesia has been associated with potential benefits concerning reduction in the odds of stroke, death and hospital costs. It will be also analysed the recommendations published by the European Society for Vascular Surgery ESVS and the singular results from a personal experience. Local versus general anaesthesis in carotid endarterectomy: a systematic review of the evidence.
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Open Access Peer-Reviewed. Article Open Access Peer-Reviewed. Article About the authors Statistics Comments Related content ABSTRACT Objective: To evaluate morbidity and mortality of carotid endarterectomy performed under regional cervical block, taking into account duration of surgery, use of shunt, conversion to general anesthesia, surgical complications, stay of patients inthe intensive care unit ICU and in the hospital, and patients' evolution over one year.
Neurologic monitoring consisted of continuous assessment of alertness and motor activity of patients during the operation. The mean age was Results: There were three 4.
The mean duration of surgery was minutes. The use of a shunt was necessary in six 8. Two 2. Restenosis occurred in three 4. The mean times of stay in the ICU and hospital were 1. There were no deaths, strokes or acute myocardial infarctions.
Conclusion: Carotid endarterectomy with conscious patient is a good alternative for selected patients at high surgical risk for general anesthesia. Patients with carotid atherosclerotic disease are mostly elderly and have varying associated comorbidities, a situation that limits surgical treatment, due to the necessity of general anesthesia GA invasive monitoring and all the consequences involved. Thus, carotid arterial endarterectomy CAE using a regional cervical block is a "minimally invasive" intervention as the reduced bleeding and relatively short time of operation interfere less in the homeostatic mechanisms of the patient [4, 5] Based on this, we independently evaluated the age and surgical risk, the operative time, the necessity of an intra-operative shunt, conversion rate to GA, surgical complications, times in the intensive care unit ICU and in the hospital, evolution at one year of follow-up of patients who underwent CAE, using a regional cervical block in our service.
Sixty-seven CAE were performed with regional cervical blocks in 61 patients in the period from June of to January of Patients The ages of the patients varied from 47 to 97 years old, with a mean of Other data related to the demographic profile and pre-operative symptoms are shown in Table 1. In respect to the comorbidities, 45 patients suffered from hypertension; 17 from diabetes; 21 from coronary arterial disease and 12 from pneumopathy Figure 1.
Anesthetic technique The anesthetic technique employed was the Labat technique . In dorsal decubitus position the head of the patient is turned to the side. The point of the mastoid process, the transverse process of the 5th cervical vertebra and the anterior tubercle of the 6th cervical vertebra were employed as points of reference in order to locate the ends of the transverse processes of the C2 to C4 vertebras. Laterally to these processes, intradermic injections of 5 mL of marcaine solution at 0.
Operative technique A lengthwise cervical incision parallel to the anterior edge of the sternocleidomastoid muscle was performed; internal and external common carotid arteries were individualized and after heparinization were occluded and the neurological conditions of the patient were observed.
After that, the plaque was removed by arteriotomy, which was closed using bovine pericardium. Neurological monitoring was achieved by means of observation of the motor functioning of the contralateral limbs and of the level of conscience, by asking simple questions initiated before the surgery and repeated during the operative course.
A shunt was established when there was motor deficits or a drop in the level of consciousness. After the surgery, the patients were transferred to the ICU. Following the release of the patients from hospital, they were evaluated by the same surgeon 30 days and one year after the surgical procedure when duplex scans of the carotid arteries were performed. The surgery was performed on the left artery in 39 Patients with bilateral carotid disease were submitted to bilateral endarterectomy on two occasions with the symptomatic side operated first.
Thirteen Conversion to GA was necessary in two cases due to agitation and lack of collaboration of the patients and in six cases the establishment of intra-luminal shunts was necessary, because the patients presented with drops in the level of consciousness and neurological deficits. No deaths, strokes or peri-operative acute myocardial infarcts AMI occurred. Episodes of mental confusion were evidenced in the postoperative periods of two patients as was a case of infection of the operative wound which was successfully treated with oral antibiotic therapy.
In the follow-up period stenosis of the carotid artery due to thrombosis was detected in three cases, two of which were treated by redo endarterectomy and the other, in which bilateral thrombosis occurred, was treated by a redo surgery on one side and angioplasty with stent placement on the other. No deaths, strokes or AMIs were reported during the one-year follow-up period. The complications that occurred are summarized in Table 2.
The mean stays in the ICU and hospital were l. All scientific articles published at bjcvs.
Manejo anestésico en el paciente geriátrico sometido a endarterectomía carotídea
Open Access Peer-Reviewed. Article Open Access Peer-Reviewed. Article About the authors Statistics Comments Related content ABSTRACT Objective: To evaluate morbidity and mortality of carotid endarterectomy performed under regional cervical block, taking into account duration of surgery, use of shunt, conversion to general anesthesia, surgical complications, stay of patients inthe intensive care unit ICU and in the hospital, and patients' evolution over one year. Neurologic monitoring consisted of continuous assessment of alertness and motor activity of patients during the operation. The mean age was Results: There were three 4.
Carotid endarterectomy under regional anesthesia: follow-up of patients. Os pacientes foram avaliados retrospectivamente. Cervical carotid stenosis is one of the main causes of ischemic stroke. Carotid endarterectomy is a safe procedure for treatment of moderate and severe symptomatic and asymptomatic carotid stenosis. Regional anesthesia allows neurological evaluation of the patient during the surgery. We reviewed the results of patients operated on at our institution under regional anesthesia during the period of April and May The patients were followed from one to 72 months Mean: