Karotid endarterektomi için lokal veya genel anestezi: Hangi anestezi tekniği tercih edilmelidir?

Amaç: Karotid endarterektomi, karotid stenoz bulunan hastalarda sakatlığı veya ölümcül inmeyi engellemek için uygulanan bir prosedürdür. Bu çalışmanın amacı genel veya lokal anestezi teknikleri altında karotid endarterektomi uygulanan hastaları analiz ederek karşılaştırmak ve lokal anestezi yönteminin postoperatif morbidite ve mortalite açısından genel anesteziden daha üstün olup olmadığını belirlemektir. Yöntemler: Kasım 2016 ve Ocak 2019 tarihleri arasında hastanemizin kardiyovasküler cerrahi kliniğinde ciddi karotid stenoz nedeniyle genel veya lokal anestezi altında karotid endarterektomi prosedürü uygulanan toplam 80 hasta bu prospektif kohort çalışmaya dahil edilmiştir. Prosedür 40 hastada genel ve 40 hastada lokal anestezi altında uygulanmıştır, ve çalışma grupları genel anestezi grubu ve lokal anestezi grubu olarak ikiye ayrıldı. İki grup sosyodemografik özellikler, preoperatif risk faktörleri, postoperatif komplikasyonlar, operasyon süresi ve hastanede kalış süresi açısından değerlendirilmiştir. Bulgular: İki grup arasında yaş ve cinsiyet açısından anlamlı bir fark saptanmamıştır (sırasıyla P=0,665, P=0,636). Benzer şekilde genel anestezi ve lokal anestezi grupları arasında asemptomatik hastaların oranı, inme veya miyokard enfarktüsü insidansı açısından anlamlı fark saptanmamıştır (sırasıyla P=0,264, P=0,780, P=1,000). Postoperatif komplikasyonlardan minor strok (P=0,870), kraniyal sinir hasarı (P=0,870), hematom (P=1,000) ve internal karotis arter oklüzyonu (P=0,723) açısından iki group arasında anlamlı fark saptanmamıştır. Ortalama operasyon süresi ve hastanede kalış süresinin lokal anestezi grubunda genel anestezi grubuna kıyasla istatistiksel olarak anlamlı şekilde daha kısa olduğu saptanmıştır (sırasıyla P<0,001, P=0,655). Sonuç: Lokal anestezi ile karotid endarterektomi prosedürü için daha kısa operasyon süresi ve hastanede kalış süresi saptanmıştır. Karotid endarterektomi prosedürü için lokal anestezi kullanımının yararlarını aydınlatmak amacıyla daha fazla kapsamlı prospektif çalışma gereklidir.

Anahtar Kelimeler:

Karotid endarterektomi, Lokal anestezi, Genel anestezi, Komplikasyonlar, Mortalite

Local or general anesthesia for carotid endarterectomy: Which anesthesia technique should be preferred?

Aim: Carotid endarterectomy is performed in order to prevent disability or fatal stroke in patients with carotid stenosis. The objective of this study was to analyze and compare patients undergoing carotid endarterectomy under general or local anesthesia, and to determine whether the local anesthesia method is superior to general anesthesia in terms of postoperative morbidity and mortality.Methods: A total of 80 patients who underwent carotid endarterectomy due to significant carotid arterial stenosis under general or local anesthesia in the cardiovascular surgery clinic of our hospital between November 2016 and January 2019 were included in this prospective cohort study. Forty carotid endarterectomy operations were performed under general anesthesia and 40 under local anesthesia. The study groups were divided as the general anesthesia group and local anesthesia group. Both groups were compared in terms of sociodemographic characteristics, preoperative risk factors, postoperative complications, operation time and length of hospital stay.Results: No statistically significant difference was found between the two groups in terms of age and gender (P=0.665, P=0.636; respectively). The groups were similar in terms of the rate of asymptomatic patients, stroke or myocardial infarction, postoperative complications including minor stroke, cranial nerve damage, hematoma and internal carotid artery occlusion (P=0.264, P=0.780,P=1.000, P=0.870, P=0.870, P=1.000, P=0.723, respectively). The mean operation time and length of hospital stay were statistically significantly shorter in the local anesthesia group compared to general anesthesia group (P<0.001, P=0.655; respectively).Conclusion: Local anesthesia provided shorter operation time and length of hospital stay for carotid endarterectomy procedure. Further comprehensive prospective studies are needed to clarify benefits of the use of local anesthesia for carotid endarterectomy.

Keywords:

Carotid endarterectomy, Local anesthesia, General anesthesia, Complications, Mortality,

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