Didem Melis ÖZTAŞ, Murat UĞURLUCAN, Ömer Ali SAYIN, Mustafa Özer ULUKAN, İbrahim ERDİNÇ, Metin Onur BEYAZ, Mert MERİÇ, Yılmaz ÖNAL, YAHYA YILDIZ, Zerrin SUNGUR, Ibrahim Ufuk ALPAGUT

SERVİKAL BLOK ALTINDA KAROTİS ENDARTEREKTOMİ OPERASYONU SONUÇLARIMIZ

Giriş: Karotis arter hastalığı inmenin başlıca nedenlerinden biridir ve ciddi morbidite ve mortaliteye neden olmaktadır. Operasyon sırasında uygulanan anestezi tekniklerinin birbirine üstünlüğü tartışmalıdır. Biz bu yazıda rejyonel anestezi altında opere ettiğimiz hastaların sonuçlarını paylaşmayı amaçladık. Gereç ve yöntem: Ocak 2010 – Aralık 2018 yılları arasında 360 hastada 412 karotisendarterektomi operasyonu uygulanmıştır. Tüm operasyonlar servikal blok tekniği ile uygulanan rejyonel anestezi altında gerçekleştirilmiştir. Hastalar retrospektif olarak demografik özellikler, shunt kullanımı, operasyon süresi, peroperatif nörolojik olay, morbidite, mortalite, hastanede kalış süresi, reeksplorasyon gereksinimi, restenoz, kan ve kan ürünleri ihtiyacı açısından irdelenmiştir. Bulgular: Hastaların 112’si kadın, 248’i erkekti. 328 hasta geçmişte ya da aktif olarak sigara kullanıcısıydı. 246 hastada diabetesmellitus, 280 hastada hipertansiyon, 312 hastada hiperlipidemi mevcuttu. 290 hastada koroner arter hastalığı öyküsü vardı.Hiçbir hastada operasyon sırasında genel anesteziye geçme ihtiyacı olmadı, mortalite veya nörolojik olay gelişmedi. 27 hastada klemp testini tolere edememesi nedeniyle shunt kullanımı gerekti. 2 hasta erken dönemde kaybedildi. 2 hastaya hematom nedeniyle eksplorasyon gerekti. Hiçbir hastada major nörolojik olay gelişmedi. Sonuç: Rejyonel anestezi uyanık hastada anlık nörolojik muayeneye olanak vermesi, operasyon süresi, hastanede yatış zamanı, kan ve kan ürünü kullanımını azaltması gibi avantajları ile birlikte karotisendarterektomisinde önemli rol oynamaktadır.

OUR RESULTS OF CAROTID ENDARTERECTOMY OPERATION UNDER CERVICAL BLOCK

Introduction: Carotid artery disease is one of the most important etiologic factors of the stroke and causes serious mortality and morbidity. The superiority of anesthesia techniques applied during the operation is controversial. We aimed to presentour results of the patients who underwent operation with regionalanethesia. MaterialandMethod: Between January 2010-December 2018, 412 carotid endarterectomy operations were performed among 360 patients. All operations were performed under regional anethesia applied with cervical block technique. The patients are examined retrospectively according to demographic features, shunt usage, operation time, peroperative neurological event, morbidity, mortality, hospital stay, reexploration requirement, restenosis, blood and blood products requirement. Results: 112 patients were female, 248 patients were male.328 patients were active or exsmoker. 246 patients had diabetes mellitus, 280 patients had hypertension, 312 patients had hyperlipidemia. 290 patients had diagnosis of coronary artery disease. In any patient, the general anesthesia requirement were needed during the operation, mortality or neurological event did not ocur. 27 patients required shunt due to crossclampin tolerance. 2 patients were lost in early followup. 2 patients required reexploration due to hematoma. Major neurological event did not ocur in any patient. Conclusion: Regional anesthesia has an important role in carotidendarterectomy with advantages of providing instant neurological examination and decreasing operation time, hospital stay and blood and blood product usage.

PDF

___

1. Burton BN, FinneranIv JJ, Harris KK, Swisher MW, Ingrande J, Said ET, et al. Association of Primary Anesthesia Type with Postoperative Adverse Events After Transcarotid Artery Revascularization. J Cardiothorac Vasc Anesth 2020; 34(1): 136- 42.
2. Lomivorotov VV, Shmyrev VA, Nepomniashchikh VA. Regional versus general anesthesia for carotid endarterectomy: do we need another randomized trial?. J Cardiothorac Vasc Anesth 2019 ; 33(4): 943-4.
3. Grieff AN, Dombrovskiy V, Beckerman W, Ventarola D, Truong H, Huntress L et al. Regional anesthesia is associated with cranial nerve ınjury in carotid endarterectomy. Ann Vasc Surg 2020 pii: S0890-5096(20)30010-8. doi: 10.1016/j.avsg.2019.12.033. (Epubahead of print).
4. Vieira-Andrade JD, Rocha-Neves JP, Macedo JP, Dias-Neto MF. onset of neurological deficit during carotid clamping with carotid endarterectomy under regional anesthesia ıs not a predictor of carotid restenosis. Ann Vasc Surg 2019; 61: 193-202.
5. Malik OS, Brovman EY, Urman RD. The use of regional or local anesthesia for carotid endarterectomies may reduce blood loss and pulmonary complications. J Cardiothorac Vasc Anesth 2019; 33(4): 935-42.
6. Kalko Y, Kafali E, Aydin U, Kafa U, Kosker T, Basaran M et al. Surgery of thecarotidartery: local anaesthesia versus general anaesthesia. Acta Chir Belg 2007; 107(1): 53-7.
7. Dakour-Aridi H, Gaber MG, Khalid M, Patterson R, Malas MB. Examination of the interaction between method of anesthesia and shunting with carotidend arterectomy. J Vasc Surg 2019. pii: S0741-5214(19)32305-5. doi: 10.1016/j.jvs.2019.08.248. [Epubahead of print]
8. DakourAridi H, Paracha N, Nejim B, Locham S, Malas MB. Anesthetic type and hospital outcomes after carotid endarterectomy from the Vascular Quality Initiative database. J Vasc Surg 2018 ; 67(5):1419-28.
9. Kim JW, Huh U, Song S, Sung SM, Hong JM, Cho A.Outcomes of carotid endarterectomy according to the anesthetic method: general versus regional anesthesia.Korean J Thorac Cardiovasc Surg 2019; 52(6): 392-9.
10. Ugurlucan M, Filik ME, Caglar IM, Zencirci E, Sayin OA, Aydiner O, Yildiz Y, Basaran M, Cicek S. Carotid endarterectomy using a "home-constructed" shunt for patients intolerant to cross-clamping. Surg Today 2015; 45(3):284-9.
11. Macfarlane AJR, Vlassakov K, Elkassabany N. Regional anesthesia for vascular surgery: does the anesthetic choice influence outcome? Curr Opin Anaesthesiol 2019; 32(5): 690-6.
12. Mracek J, Kletecka J, Mork J, Stepanek D, Dostal J, Mrackova J et al. Indications for general versus local anesthesia during carotid endarterectomy. J NeurolSurg A Cent Eur Neurosurg 2019 ; 80(4):250-4.
13. Orlický M, Hrbáč T, Sameš M, Vachata P, Hejčl A, Otáhal D et al. Anesthesia typedetermines risk of cerebral infarction after carotid endarterectomy. J Vasc Surg 2019; 70(1): 138-47.
14. Szabó P, Mayer M, Horváth-Szalai Z, Tóth K, Márton S, Menyhei G, et al. Awake sedation with propofol attenuates ıntra operative stress of carotid endarterectomy in regional anesthesia. Ann Vasc Surg 2020; 63: 311-8.
15. Scimia P, Giordano C, Basso Ricci E, Petrucci E, Fusco P. The ultrasound-guided C2-C4 compartment block combined to dexmedetomidine sedation: an ideal approach for carotid endarterectomy in awake patients. Minerva Anestesiol 2018; 84(10): 1226-7.
16. Sinha S, Fok M, Goh A, Gadhvi VM. Out comes after transverse-ıncision 'mini' carotid endarterectomy and patch-plasty. Vasc Specialist Int 2019; 35(3): 137-44.