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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 1998 March;5(1):29-42
language: English, Italian
Local versus general anesthesia in carotid artery surgery
Mangiacotti B., Forliti E., Varroni A., Panella L. *, Aloisi P. **, Petrassi C., Ventura M., Spartera C.
From the Chair of Vascular Surgery (Head: Prof. C. Spartea) University of L’Aquila, L’Aquila, Italy
* Anesthesia and Reanimation Unit ** Neurophysiopathology Unit Hospital S. Salvatore, L’Aquila, Italy
Background. Anesthesiological technique is important both for the prevention of clamping ischemia and cerebral protection during carotid endarterectomy (CEA). A review of randomised and non-randomised studies reported in the literature did not show a clear superiority of general anesthesia (GA) versus locoregional anesthesia (LRA) with comparable perioperative complications. The aim was to determine some technical and clinical aspects of LRA compared to GA and to assess whether the “choice of anesthesia” may influence perioperative results in patients undergoing CEA. In particular, we analysed the trend of tensive values during surgery and perioperative complications.
Methods. 300 consecutive CEAs, of which 226 (75.3%) in LRA and 74 (24.7%) in GA, were studied retrospectively.
Results. The tensive values in the LRA group were more stable with better cardiovascular response to carotid clamping and subsequent increase in cerebral perfusion.
Conclusions. Even if anesthesiological technique does not influence the final results of CEA, there are several advantages to the use of LRA, such as better neurological control and shorter hospital stay. Contraindications to LRA are refusal by the patient, anatomical difficulties and if the clamping tolerance test during surgery requires the use of a shunt.