VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2005 August;46(4):431-6

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Effectiveness and safety of carotid endarterectomy under remifentanil

Coppi G. ^{1, 2}, Moratto R. ^{1, 2}, Ragazzi G. ^{1, 2}, Nicolosi E. ^{1, 2}, Silingardi R. ^{1, 2}, Benassi Franciosi G. ^{1, 2}, Rambaldi M. ^{1, 2}, Navi A. ^{1, 2}, Ciardullo A. V. ²

¹ Department of Vascular Surgery S. Agostino Hospital, Modena, Italy 2 Local Health Unit, Modena, Italy

Aim. The aim of this study was to evaluate the effectiveness and safety of carotid endarterectomy (CEA) with conscious sedation under remifentanil (Remifentanil anesthesia - RA) vs conventional loco-regional anesthesia (Conventional-LRA) in the current practice of a vascular surgery unit.
Methods. We introduced the “Remifentanil-RA” in our practice according to a two-step protocol. In the first step we performed a pilot prospective study to assess the procedure’s safety and reproducibility in our setting on 60 consecutive patients with symptomatic and/or high-grade (>70%) internal carotid artery stenosis and alternately assigning them either to “Remifentanil-RA” or “Conventional-LRA” CEA. In the second step we analysed our routine operative records as to effectiveness and safety on 533 patients who consecutively underwent “Remifentanil-RA” CEA. We compared them with 533 age- and sex-matched historical controls who underwent “Conventional-LRA” CEA.
Results. The patients’ mean age was 71.2±6.8 vs 71.8±6.1 (“Remifentanil-RA” vs “Conventional-LRA”). About 73% of them were male and 56% had a symptomatic carotid stenosis. Neither the pilot study nor second step comparison showed differences in outcome measures. We found only higher peri-operative nausea/ vomit (3.6% vs 0.4% “Remifentanil-RA” vs “Conventional-LRA”, P<0.0002) and fewer re-operations for post-operative hematomas (3% vs 5.4% respectively, P=0.048).
Conclusion. We found that “Remifentanil-RA” CEA was safe, effective and satisfactory. Nevertheless, with the potential problems of intubation and those already found with side effects, a randomized control trial (RCT) is needed in order to prove that this method is superior to “Conventional-LRA” CEA.