ORIGINAL ARTICLES   

Giornale Italiano di Chirurgia Vascolare 1998 March;5(1):29-42

Copyright © 2000 EDIZIONI MINERVA MEDICA

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.