General anesthesia management in carotid endarterectomy surgery: a single center experience

Carotid endarterectomy (CEA) is an effective surgery which is applied in order to reduce the risk of stroke associated with severe stenosis of the carotid artery. Anesthesia management is important in these patients due to high incidence of cardiovascular disease and studies are in progress for ideal anesthesia management. In this study, we aimed to share our experience in carotis endarterectomy and evaluate the clinical outcomes and review retrospectively. Patients informations were obtained from the patients and anesthesia records. Age, ASA physical status, Mallampati score (MP), anesthesia and surgery duration, ICU and discharge time, blood transfusion rate, anesthetic and analgesic drugs, invasive procedures, complications, smoking, stenosis side and ratio, comorbid conditions of patients and drugs were recorded. The mean age of patients was 67.19±1.07 . It was evaluated that 44 patients (61.2%) were ASA II, 28 patients (38.8%) were ASA III. It was recorded that mean duration of anesthesia was 226.25 ± 37.99 min, duration of surgery was 195.83±38 min, ICU stay was 2.45 ± 2.52 days and hospital stay time was 5.23 ± 2.77 days. 29 of patients (40.3%) were smokers and 7 of patients (9.7%) were identified as secondary smokers. The mortality rate was 6.9% (5 patients). Clinical experience and outcome data from our study are consistent with the literature. In CEA surgery, anesthetic technique that is safe enough to guide the evidence is not there yet. Experience of the anesthesiologist and the surgeon as surgical anesthetic management of CEA is an important point to be noted that the current developments in the patient's characteristics and monitoring

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1. European Carotis Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: Interim results for symptomatic patients with severe (70-99%) or mild (0-29%) carotid stenosis. Lancet. 1991;337(8752):1235-43.

2. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Benefical effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Eng J Med. 1991;325(7):445-53.

3. Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, Biasi G, Norgren L; ESVS Guidelines Collaborators. ESVS guidelines. Invasive tratment for carotid stenosis:indications, techniques. Eur J Vasc Endovasc Surg. 2009;37(4):1-19.

4. Harbaugh KS, Harbaugh RE. Early discharge after carotid endarterectomy. Neurosurgery. 1995;37(2):219-25.

5. Gümüş F, Erkalp K, Şinikoğlu SN, Sevdi MS, Yektaş A, Polat A, Kayalar N, Alagöl A. Genel anestezi ile karotis endarterektomi ameliyatlarında bispektral indeks monitörizasyonunun etkinliği. GKDA Derg. 2013;19(1):31-6.

6. Watts K, Lin PH, Bush RL, Award S, MsCoy SA, Felkai D, Zhou W, Nguyen L, Guerrero Ma, Shenaq Sa, Lumsden Ab. The impact of anesthtetic modality on the outcome of carotid endaretectomy. Am J Surg. 2004;188(6):741-7.

7. GALA Trial Collaborative Group, Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, Torgerson D, Dellagrammaticas D, Horrocks M, Liapis C, Banning AP, Gough M, Gough MJ. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicenter, randomised controlloed trial. Lancet. 2008;372(9656:2132-42.

8. Wang Q, Li YH, Wang TL, Feng H, Cai B. Prospective effect of lowdose sevoflurane inhalation and propofol anesthesia on the myocardium after carotid endarterectomy: A randomised controlled trial. Chin Med J. 2015;128(14):1862-6.

9. Allen BT, Anderson CB, Rubin BG, Thompson RW, Flye MW, Young-Beyer P, Frisella P, Sicard GA. The influence of anesthetic technique on perioperative complications after carotid endarterectomy. J Vasc Surg. 1994;19(5):834-42.

10. Muskett A, McGreevy J, Miller M. Detailed comprasion of regional and general anesthesia for carotid endareterectomy. Am J Surg. 1986;152(6):691-4.

11. Kasprzak PM, Altmeppen J, Angerer M, Mann S, Mackh J, Topel I. General versus locoregional anesthesia in carotid surgery: A prospective randomised trial. Vasa. 2006;35(4):232-8.

12. Forssell C, Takolander R, Bergqvist D, Johansson A, Persson NH. Local versus general anesthesia in carotid surgery: A prospective randomised study. Eur J Vasc Surg. 1989;3(6):503-9.

13. Santamaria G, Britti RD, Tescione M, Moschella A, Bellinvia C. Comprasion between local and general anesthesia for carotid endareterectomy. Minerva Anestesiol. 2004;70(11):771-8.

14. Sternbach Y, Illing KA, Zhang R, Shortell CK, Rhodes JM, Davies M. Hemodynamic benefits of regional anesthesia for carotid endarterectomy. J Vasc Surg. 2002;35(2):333-9.

15. Riles TS, Fischer FS, Schaefer S, Pasternak PF, Baumann FG. Plasma catecholamines concentrations during abdominal aortic aneurysm surgery: the link to perioperative myocardial ischemia. Ann Vasc Surg. 1993;7(3):213-20.

16. Marrocco-Trischitta MM, Tiezzi A, Svampa GM. Perioperative stress response to carotid endarterectomy:the impact of anesthetic modality. J Vasc Surg. 2004;39:1295-304.

17. Hye RJ, Voeks JH, Malas MB, Tom M, Longson S, Blackshear JL, Brott TG. Anesthetic type and risk of myocardial infarction after carotid endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). J Vasc Surg. 2016,64(1):3-8.

18. Siu A, Patel J, Hashemi H, Mukherjee D. A Cost-Effective Analysis Comparing Regional to General Anesthesia for Carotid Endarterectomy. J Vasc Surg. 2015;61(6):101S.

19. Camerani S, Capuzzo M, Ieffa E, Pescolderung M, Braccini L, Volta CA. Total intravenous anesthesia with superficial cervical block or morphine transition in patients undergoing carotid endarterectomy. Minerva Anestesiol. 2014;80(6):676-84.

20. Santis FD, Chaver CM, Pattaro C, Cesareo V, Cintio VD. A prospective nonrandomised study on carotid surgery performed under general anesthesia without intraoperative cerebral monitoring. J Stroke Cerebrovasc Diseas. 2016;25(1):136-43.

21. Casati A, Spreafico E, Putzu M, Fanelli G. New technology for noninvazive brain monitoring: continuous serebral oximetry. Minerva Anestesiol. 2006;72(7-8):605-25.

22. Howell SJ. Carotid endarterectomy. BJ Anaesth. 2007;99(1):119-31.

23. Erward J. Norris. Chapter 52:Anesthesia for Vascular Surgery. Miller RD, Ed. Miller’s Anesthesia, sixth edition, Churchill Livingstone. 2004;2100-4.

24. Godet G, Watremez C, El Kettani C, Soriano C, Coriat P. A comparasion of sevoflurane, target-controlled infusion propofol and propofol/sevoflurane anesthesia in patients undergoing carotid surgery:a quality of anesthesia and recovery profile. Anesth Analg. 2001;93:560-5.

25. Riles TS, Kopelman I, Imparato AM. Myocardial infarction following carotid endarterectomy: A review of 683 patients. Surg. 1979;85(3):249-52.

26. Lusby RJ, Wylie EJ. Complications of carotid endarterectomy. Surg Clin North Am.1983;63(6):1293-302.

27. Umbrain V, Keeris J, D’Haese J, Verborgh C, Debing E, Van den Brande P, Camu F. Isoflurane, desflurane and sevoflurane for carotid endarterectomy. Anaesthesia. 2000;55(11):1052-7.

28. Karasu A, Kuşçu DY, Bakaç G, Ofluoğlu E, Akkoyun N, Yalçıner B, Dayan C, Bahar S, Kiriş T, Uye M, Toplamoğlu H. Carotid Endarterectomy with Regional Anesthesia: An Audit of 71 cases. Turk Neurosurg. 2009;19(1):21-8.
Medicine Science-Cover
  • ISSN: 2147-0634
  • Yayın Aralığı: Yılda 4 Sayı
  • Başlangıç: 2012
  • Yayıncı: Effect Publishing Agency ( EPA )
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