CAROTID ENDARTERECTOMY WITH REGIONAL ANESTHESIA IN OUR EXPERIENCE

Yıl 2022, Cilt: 13 Sayı: 4, 540 - 544, 30.12.2022

Serkan Mola , Gokay Denız , Emre Yasar , Seda Kurtbeyoglu , Alp Yıldırım , Ayla Ece Celikten

https://doi.org/10.18663/tjcl.1191932

Öz

CAROTID ENDARTERECTOMY WITH REGIONAL ANESTHESIA IN OUR EXPERIENCE

Aim: Carotid endarterectomy (CEA) is a common revascularization option for carotid atherosclerosis. Regional anesthesia for CEA has become a preferred anesthesia technique in lots of centers. In this study, we present our experience with CEAs under regional anesthesia.
Material and Methods: From 2019 to 2022, 271 patients who underwent CEA with regional anesthesia in two centers were included. Retrospectively, patient data, demographical characteristics, comorbidities, and radiological imaging features were enrolled by searching the hospital information system. The primary endpoint was to describe the outcomes.
Results: Of the 271 participants, 202 were male and 69 were female. The male-to-female ratio is 74.5. The average age was 65.3±10,2. General anesthesia was maintained for two patients due to inadequate patient collaboration. The average operation time was 52±8.9 minutes. The mean X-clamp time was 14±2.5 minutes and the patient stayed in the intensive care unit for an average of 14±2 hours. The most common postoperative complication was bleeding (n=8). No cranial nerve damage was observed. There was no procedural death. Patients were discharged within an average of 4 days.
Conclusion: Regional anesthesia can be safely performed for CEA. Considering patient preference and compliance, regional anesthesia is the first option for CEA operations in our routine.
Keywords: carotid artery stenosis, carotid endarterectomy, regional anesthesia

Anahtar Kelimeler

carotis, endarterectomy, regional anesthesia, stroke

CAROTID ENDARTERECTOMY WITH REGIONAL ANESTHESIA IN OUR EXPERIENCE

Öz

Aim: Carotid endarterectomy (CEA) is a common revascularization option for carotid atherosclerosis. Regional anesthesia for CEA has become a preferred anesthesia technique in lots of centers. In this study, we present our experience with CEAs under regional anesthesia.
Material and Methods: From 2019 to 2022, 271 patients who underwent CEA with regional anesthesia in two centers were included. Retrospectively, patient data, demographical characteristics, comorbidities, and radiological imaging features were enrolled by searching the hospital information system. The primary endpoint was to describe the outcomes.
Results: Of the 271 participants, 202 were male and 69 were female. The male-to-female ratio is 74.5. The average age was 65.3±10,2. General anesthesia was maintained for two patients due to inadequate patient collaboration. The average operation time was 52±8.9 minutes. The mean X-clamp time was 14±2.5 minutes and the patient stayed in the intensive care unit for an average of 14±2 hours. The most common postoperative complication was bleeding (n=8). No cranial nerve damage was observed. There was no procedural death. Patients were discharged within an average of 4 days.
Conclusion: Regional anesthesia can be safely performed for CEA. Considering patient preference and compliance, regional anesthesia is the first option for CEA operations in our routine.
Keywords: carotid artery stenosis, carotid endarterectomy, regional anesthesia

Anahtar Kelimeler

carotis

Kaynakça

• 1. Velz J, Esposito G, Wegener S, Kulcsar Z, Luft A, Regli L: [Diagnostic and Therapeutic Management of Carotid Artery Disease]. Praxis (Bern 1994) 2020, 109(9):705-723.
• 2. Naylor AR, Ricco JB, de Borst GJ, Debus S, de Haro J, Halliday A, Hamilton G, Kakisis J, Kakkos S, Lepidi S et al: Editor's Choice - Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018, 55(1):3-81.
• 3. Yılmaz F: Anesthesia Management for Carotid Endarterectomy: Review Article. e-Journal of Cardiovascular Medicine 2019, 7:50-59.
• 4. Ferguson GG, Eliasziw M, Barr HW, Clagett GP, Barnes RW, Wallace MC, Taylor DW, Haynes RB, Finan JW, Hachinski VC et al: The North American Symptomatic Carotid Endarterectomy Trial : surgical results in 1415 patients. Stroke 1999, 30(9):1751-1758.
• 5. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998, 351(9113):1379-1387.
• 6. Harky A, Chan JSK, Kot TKM, Sanli D, Rahimli R, Belamaric Z, Ng M, Kwan IYY, Bithas C, Makar R et al: General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2020, 34(1):219-234.
• 7. Grieff AN, Dombrovskiy V, Beckerman W, Ventarola D, Truong H, Huntress L, Rahimi S: Anesthesia Type is Associated with Decreased Cranial Nerve Injury in Carotid Endarterectomy. Ann Vasc Surg 2021, 70:318-325.
• 8. Rerkasem A, Orrapin S, Howard DP, Nantakool S, Rerkasem K: Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev 2021, 10:CD000126.
• 9. Gomes M, Soares MO, Dumville JC, Lewis SC, Torgerson DJ, Bodenham AR, Gough MJ, Warlow CP, Group GC: Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery (GALA Trial). Br J Surg 2010, 97(8):1218-1225.
• 10. Kim JW, Huh U, Song S, Sung SM, Hong JM, Cho A: Outcomes of Carotid Endarterectomy according to the Anesthetic Method: General versus Regional Anesthesia. Korean J Thorac Cardiovasc Surg 2019, 52(6):392-399.
• 11. Zipfel J, Bantle SJ, Magunia H, Schlensak C, Neunhoeffer F, Schuhmann MU, Lescan M: Non-Invasive Cerebral Autoregulation Monitoring During Awake Carotid Endarterectomy Identifies Clinically Significant Brain Ischaemia. Eur J Vasc Endovasc Surg 2020, 60(5):647-654.
• 12. Tan TW, Garcia-Toca M, Marcaccio EJ, Jr., Carney WI, Jr., Machan JT, Slaiby JM: Predictors of shunt during carotid endarterectomy with routine electroencephalography monitoring. J Vasc Surg 2009, 49(6):1374-1378.
• 13. Corson JD, Chang BB, Shah DM, Leather RP, DeLeo BM, Karmody AM: The influence of anesthetic choice on carotid endarterectomy outcome. Arch Surg 1987, 122(7):807-812.
• 14. Bergeron P, Benichou H, Rudondy P, Jausseran JM, Ferdani M, Courbier R: Stroke prevention during carotid surgery in high risk patients (value of transcranial Doppler and local anesthesia). J Cardiovasc Surg (Torino) 1991, 32(6):713-719.
• 15. Scuderi PE, Prough DS, Davis CH, Jr., Balestrieri FJ, McWhorter JM, Howard G: The effects of regional and general anesthesia on blood pressure control after carotid endarterectomy. J Neurosurg Anesthesiol 1989, 1(1):41-45.
• 16. Gabelman CG, Gann DS, Ashworth CJ, Jr., Carney WI, Jr.: One hundred consecutive carotid reconstructions: local versus general anesthesia. Am J Surg 1983, 145(4):477-482.
• 17. Mendonca CT, Fortunato JA, Jr., Carvalho CA, Weingartner J, Filho OR, Rezende FF, Bertinato LP: Carotid endarterectomy in awake patients: safety, tolerability and results. Rev Bras Cir Cardiovasc 2014, 29(4):574-580.
• 18. Peitzman AB, Webster MW, Loubeau JM, Grundy BL, Bahnson HT: Carotid endarterectomy under regional (conductive) anesthesia. Ann Surg 1982, 196(1):59-64.