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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2004 November;70(11):771-8

language: English, Italian

Comparison between local and general anaesthesia for carotid endarterectomy. A retrospective analysis

Santamaria G., Britti R. D., Tescione M., Moschella A., Bellinvia C.

Unit of Anesthesia and Pain Therapy Ospedali Riuniti, Reggio Calabria, Italy


Aim. The aim of ­this ­study was to com­pare by a ret­ro­spec­tive anal­y­sis ­local anes­the­sia (LA) ver­sus gen­er­al anes­the­sia (GA) for carot­id endar­te­rec­to­my (CEA).
Methods. Two-hun­dred and 59 ­patients who under­went CEA, at the Ospedali Riuniti of Reggio Calabria in the peri­od 2000-2001, ­were ­enrolled in ­this ­study. For anal­y­sis pur­pos­es, ­patients ­were divid­ed ­into 4 ­groups, accord­ing to ­their neu­ro­log­i­cal stat­us and to the ­type of anes­the­sia. LA was ­induced ­either by ­deep and super­fi­cial cer­vi­cal plex­us ­block (­side ­approach accord­ing to Moore). GA was ­induced ­with pro­pof­ol and main­tained ­with sevof­lu­rane. Monitoring of the neu­ro­log­i­cal stat­us was ­achieved by sim­ple clin­i­cal eval­u­a­tion of the ­state of con­scious­ness ­under LA, and by con­tin­u­ous EEG ­under GA.
Results. With LA, a reduc­tion in the dura­tion of inter­ven­tion and hos­pi­tal ­stay, in the num­ber of neu­ro­log­i­cal com­pli­ca­tions and con­se­quent intra­op­er­a­tive ­shunts was ­observed, and admis­sion to the inten­sive ­care ­unit (ICU) was nev­er ­required. With GA bet­ter ­blood pres­sure con­trol was ­achieved, but ­more intra­op­er­a­tive ­shunts and admis­sions to ICU ­were ­required, ­thus increas­ing over­all ­costs.
Conclusion. In our expe­ri­ence, LA ­seems to be the ­approach of ­choice for CEA ­because 1) by pre­serv­ing the ­state of con­scious­ness, it ­allows a sim­ple clin­i­cal mon­i­tor­ing of cere­bral per­fu­sion main­te­nance; 2) it reduc­es the num­ber of intra­op­er­a­tive ­shunts and the ­risk of admis­sion to the ICU; 3) it is ­cost-effec­tive.

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