Anesthesia for carotid endarterectomy

Current Opinion in Anaesthesiology

Volumn 11, Issue 5, 1998, Pages 479-484

  Lineberger, Catherine K ^a,b   Lubarsky, David A ^a  

^a DUKE UNIVERSITY   (United States)

^b DUKE UNIVERSITY MEDICAL CENTER   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADRENALIN; BUPIVACAINE; CLONIDINE; ISOFLURANE; LIDOCAINE; NITROUS OXIDE PLUS OXYGEN; OXYGEN; PROPOFOL; REMIFENTANIL; SEVOFLURANE; THIOPENTAL;

ANESTHESIA; ANESTHESIA INDUCTION; BRAIN BLOOD VESSEL; CAROTID ARTERY OBSTRUCTION; CAROTID ENDARTERECTOMY; CEREBROVASCULAR DISEASE; CLINICAL PATHWAY; HEMODYNAMICS; HOSPITALIZATION; HUMAN; INTENSIVE CARE UNIT; LARYNGEAL MASK; MYOCARDIAL DISEASE; NERVE BLOCK; OXYGEN TISSUE LEVEL; PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY; PRIORITY JOURNAL; REVIEW; RISK FACTOR; TACHYCARDIA; TREATMENT OUTCOME;

EID: 0031790581     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001503-199810000-00005     Document Type: Review

References (25)

1. Zvara DA. Pro: regional anesthesia is the best technique for carotid endarterectomy. J Cardiothorac Vasc Anesth 1998; 12:111-114. This paper combines data from 13 studies of carotid endarterectomy to demonstrate the limited benefit of regional anesthesia over general anesthesia. However, the authors combine prospective and retrospective studies with varying study designs and so the conclusions of the paper lack validity.
2. Lineberger CK, Lubarsky DA. Con: general anesthesia and regional anesthesia are equally acceptable choices for carotid endarterectomy. J Cardiothorac Vasc Anesth 1998; 12:115-117. This is a brief review of the issues related to anesthetic choice for carotid endarterectomy, emphasizing the practical and financial factors.
3. Fiorani L, Parenti G, Marconi F. Combined transcranial Doppler and electrophysiologic monitoring for carotid endarterectomy. J Neurosurg Anesthesiol 1997; 9:11-16. This is a detailed report of the authors' experience with a series of 153 patients undergoing carotid endarterectomy with transcranial Doppler, somatosensory evoked potential and electroencephalogram monitoring. Transcranial Doppler was found to correlate well with electrophysiologic monitoring, and provided additional information about emboli and hyperperfusion syndrome.
4. Tangkanakul C, Counsell CE, Warlow CP. Local versus general anaesthesia in carotid endarterectomy: a systematic review of the evidence. Eur J Vasc Endovasc Surg 1997; 13:491-499. Twenty studies regarding anesthetic choice for carotid endarterectomy were evaluated for trial quality. Seventeen of these, representing the vast majority of patients studied, were in non-randomized studies and suggested a possible advantage of regional anesthesia with regard to outcomes and length of stay. The randomized studies contain too few patients to confirm or refute this position. The authors make a plea for a moratorium on publication of additional non-randomized retrospective comparisons.
5. Ghali R, Palazzo EG, Rodriguez DI, Zammit M, Loudenback DL, DeMuth P, et al. Transcranial Doppler intraoperative monitoring during carotid endarterectomy: experience with regional or general anesthesia, with and without shunting. Ann Vasc Surg 1997; 11:9-13. This retrospective study describes the use of transcranial Doppler and intraoperative findings.
6. Molnar RR, Davies MJ, Scott DA, Silbert BS, Mooney PH. Comparison of clonidine and epinephrine in lidocaine for cervical plexus block. Reg Anesth 1997; 22:137-142. A well-conducted, prospective study testing the hypothesis that clonidine is a comparable adjuvant to epinephrine for cervical plexus blockade, without deleterious heart rate effects.
7. Davies MJ, Silert BS, Scott DA, Cook RJ, Mooney PH, Blyth C. Superficial and deep cervical plexus block for carotid artery surgery: a prospective study of 1000 blocks. Reg Anesth 1997; 22:442-446. This is another prospective trial evaluating the efficacy, complications and patient satisfaction with cervical plexus blockade. The authors provide detailed descriptions of their technique and practical recommendations for safe use of regional anesthesia for carotid endarterectomy.
8. Fiorani P, Sbarigia E, Speziale F, Antonini M, Fiorani B, Rizzo L, Massucci M. General anaesthesia versus cervical block and perioperative complications in carotid artery surgery. Eur J Vasc Endovasc Surg 1997; 13:37-42. The authors report their experience over 10 years, during which time there was a conversion from general to regional anesthesia for carotid endarterectomy. This retrospective report focuses on the choice of anesthesia as the primary factor responsible for their improved outcome, but does not consider other confounding issues such as differences in the regional and general groups.
9. Colbert SA, O'Hanlon DM, Page R, Flanagan F, Moriarty DC. The laryngeal mask airway reduces blood flow in the common carotid artery bulb. Can J Anaesth 1998; 45:23-27. This brief report demonstrates decreased carotid artery bulb flow and lumen size with inflation of a laryngeal mask airway cuff.
10. Grady RE, Weglinski MR, Sharbrough FW, Perkins WJ. Correlation of regional cerebral blood flow with ischemic electroencephalographic changes during sevoflurane-nitrous oxide anesthesia for carotid endarterectomy. Anesthesiology 1998; 88:892-897. The authors determined a concentration of sevoflurane which allowed adequate electroencephalogram monitoring during carotid endarterectomy and used logistic regression analysis to determine the critical regional cerebral blood flow for cerebral ischemia with carotid cross-clamping.
11. Gottlieb A, Satariano-Hayden P, Schoenwald P, Ryckman J, Piedmonte M. The effects of carotid sinus nerve blockade on hemodynamic stability after carotid endarterectomy. J Cardiothorac Vasc Anesth 1997; 11:67-71.
12. Gossetti B, Martinelli O, Guerricchio R, Irace L, Benedetti-Valentini F. Transcranial Doppler in 178 patients before, during, and after carotid endarterectomy. J Neuroimag 1997; 7:213-216.
13. Finocchi C, Galdolfo C, Carissimi T, Del Sette M, Bertoglio C. Role of transcranial Doppler and stump pressure during carotid endarterectomy. Stroke 1997; 28:2448-2452. This descriptive study again confirms that stump pressures are an unreliable predictor of neurologic events in carotid endarterectomy. The authors found that microemboli were not associated with poor outcome, rather, patients with ischemic complications had higher degrees of stenosis in the contralateral carotid artery.
14. Duffy CM, Manninen PH, Chan A, Kearns CF. Comparison of cerebral oximeter and evoked potential monitoring in carotid endarterectomy. Can J Anaesth 1997; 44:1077-1081.
15. Lawrence PF, Alves JC, Douglas J, Bhirangi K, Dobrin PB. Incidence, timing and causes of cerebral ischemia during carotid endarterectomy with regional anesthesia. J Vasc Surg 1998; 27:329-337. The authors review their experience with 200 patients undergoing carotid endarterectomy under regional anesthesia. The paper reports interesting theories about the etiology of the early and late development of ischemic symptoms.
16. Ballotta E, Da Giau G, Guerra M. Carotid endarterectomy and contralateral internal carotid artery occlusion: perioperative risks and long-term stroke and survival rates. Surgery 1998; 123:234-240.
17. Rockman CB, Cappadona C, Riles TS, Lamparello PJ, Giangola G, Adelman MA, Landis R. Causes of the increased stroke rate after carotid endarterectomy in patients with previous strokes. Ann Vasc Surg 1997; 11:28-34. This is a retrospective review of over 700 carotid endarterectomies, revealing that patients with previous strokes had more severe associated medical problems, and increased severity of overall cerebrovascular disease compared with asymptomatic patients or patients with transient ischemic attacks only.
18. Criado FJ, Wellons E, Clark NS. Evolving indications for and early results of carotid artery stenting. Am J Surg 1997; 174:111-114. The authors describe their initial experience with 33 carotid artery stenting procedures.
19. Bourke BM, Crimmins DC. Overnight hospital stay for carotid endarterectomy. Med J Aust 1998; 168:157-160.
20. Friedman SG, Tortolani AJ. Reduced length of stay following carotid endarterectomy under general anesthesia. Am J Surg 1995; 170:235-236.
21. Collier PE. Carotid endarterectomy: a safe cost-effective approach. J Vasc Surg 1992; 16:926-933.
22. Perler BA, Dardik A, Burleyson GP, Gordon TA, Williams GM. Influence of age and hospital volume on the results of carotid endarterectomy: a statewide analysis of 9918 cases. J Vasc Surg 1998; 27:25-33. This is a well-done population based observational study. Carotid endarterectomy is a safe procedure even among the very elderly, who may experience a longer length of stay and higher charges correlating with their documented greater medical complexity. Hospitals with higher volumes had lower complication rates and costs.
23. Back MR, Harward TRS, Huber TS, Carlton LM, Flynn TC, Seeger JM. Improving the cost-effectiveness of carotid endarterectomy. J Vasc Surg 1997; 26:456-464. This sequential study (non-randomized) showed no difference in outcome and lower costs with a clinical pathway. Too few patients were studied to evaluate outcomes. Therefore, this is not a cost-effectiveness study, but a cost-minimization study. Whether a pathway lowers costs can only be known if rare but expensive morbidity is considered.
24. Jordan WD, Schroeder PT, Fisher WS, McDowell HA. A comparison of angioplasty with stenting vs. endarterectomy for the treatment of carotid artery stenosis. Ann Vasc Surg 1997; 11:2-8. This is an anecdotal report using a retrospective carotid endarterectomy control group. The study lacks power to make valid conclusions.
25. Jordan WD, Roye GD, Fisher WS, Redden D, McDowell HA. A cost comparison of balloon angioplasty and stenting versus endarterectomy for the treatment of carotid artery stenosis. J Vasc Surg 1998; 27:16-24. This study investigated hospital charges, which is not an entirely credible approach. Thus, the authors' conclusion that PTAS has no advantage may not be valid.