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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Anesthesia for carotid endarterectomy: where do we stand at present?

Abstract

Carotid endarterectomy (CEA) is a surgical procedure performed to reduce the incidence of embolic and thrombotic stroke. Although only a preventive procedure, CEA carries the risk of perioperative complications. There is constant searching for an optimal anesthetic technique. There are pros and cons for both anesthetic techniques used: regional (RA) and general anesthesia (GA). A large number of studies have compared RA and GA techniques in CEA surgery patients. The primary outcome was the proportion of patients with stroke, myocardial infarction, or death. However, neither the GALA trial nor the pooled analysis was adequately powered to reliably detect an effect of type of anesthesia on mortality. It may therefore be appropriate to consider other additional parameters (stress response, incidence of postoperative delirium and cognitive impairment, functional recovery, total surgery time, intensive care unit requirement, hospital stay, hospital costs and patients satisfaction) when comparing the outcomes of the two techniques.

Although, the debate continues as to whether regional anesthesia or general anesthesia is safer, the choice of anesthetic technique is a complex decision and surgical teams should be able to offer both RA and GA. The individual approach is the ideal choice and should be determined at the discretion of the surgeon, anesthetist and patient depending on the clinical situation and own preferences.

Key words: surgery, carotid endarterectomy, anesthesia, general, regional, outcome

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Anesthesia techniques for carotid endarterectomy

Abstract

Stroke is one of the leading causes of death in the modern countries. Mainstay treatment for stroke prevention is carotid endarterectomy (CEA). Patients scheduled for surgery often have many associate systemic illnesses that pose a risk of perioperative cardiac and neurological complications. Detailed preoperative evaluation of neurological and cardiac function with optimization of the systemic illnesses therapy is obligatory. Ideal anesthesiology technique should provide adequate analgesia, minimal stress response, optimal brain perfusion and oxygenation, optimal hemodynamic and myocardial oxygen balance while assuring calm and relaxed patients with good surgical comfort. Both regional anesthesia and general anesthesia have some advantages and drawbacks. Regarding to cerebral and myocardial ischemia and adverse outcome after CEA, especially in high risk patients, today still it is not clear which anesthesia technique is preferred for CEA. Greatest risk in the early postoperative period is new neurological deficit caused by cerebral ischemia end myocardial infarction caused with hemodynamic instability and therefore CEA patients are placed in the Intensive Care Unit for at least six or more hours where they are monitored for neurological and hemodynamic complications.

 

Key words: anesthesia, carotid endarterectomy

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