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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 1999 August;12(4):271-4
Carotid surgery under regional anaesthesia
Rignano A., Mezzetti R., Albanese S., Keller G. C., Vandone P. L.
Background. The anaesthetic approach, together with the surgical technique used during carotid artery surgery, must satisfy, in as far as it is possible, every criteria of safety and predispose to an ever better outcome of the procedure. Over time, general anaesthesia has been joined by regional anaesthesia in conscious or only lightly sedated patients and the choice of the anaesthetic technique to use has become the subject of investigation and debate. Design: retrospective evaluation of a series of 245 consecutive patients undergoing carotid thromboendarterectomy.
Methods. The study population included 169 patients operated on under general anaesthesia, with intraoperative monitoring by electroencephalography (EEG) and somatosensory evoked potentials (SEPs) and 76 patients who had the operation under regional anaesthesia, with continuous direct monitoring of the state of consciousness and motor functions.
Results. In 4 cases (5.2%) the regional anaesthesia was converted into general anaesthesia because of respiratory arrest (2 cases) and Jacksonian crises (2 cases) a few minutes after clamping. There were no deaths. One patient developed contralateral arm weakness, which disappeared in the hours following the operation.
Conclusions. The advantages associated with regional anaesthesia are substantially those due to the patient retaining a constant state of alertness and mobility throughout the carotid endarterectomy and the lesser uncertainty in cerebral monitoring than that afforded by the methods used during general anaesthesia. Blood pressure changes are less frequent than in patients operated on under general anaesthesia. Cerebral parenchymal oxygen consumption is greater in conscious patients than in sedated patients protected by thiobarbiturates. The total number of shunts used in all the operations was the same, irrespective of the type of monitoring used, which is, in fact, a confirmation of the efficacy of EEC and SEP investigations of cerebral function.