Outcomes of Carotid Endarterectomy according to the Anesthetic Method: General versus Regional Anesthesia
10.5090/kjtcs.2019.52.6.392
- Author:
Jong Won KIM
1
;
Up HUH
;
Seunghwan SONG
;
Sang Min SUNG
;
Jung Min HONG
;
Areum CHO
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea. tymfoo82@gmail.com
- Publication Type:Original Article
- Keywords:
Carotid arteries;
Endarterectomy;
Anesthesia;
Shunts
- MeSH:
Anesthesia;
Anesthesia, Conduction;
Anesthesia, General;
Carotid Arteries;
Cervical Plexus Block;
Endarterectomy;
Endarterectomy, Carotid;
Follow-Up Studies;
Humans;
Length of Stay;
Medical Records;
Methods;
Mortality;
Myocardial Infarction;
Operative Time;
Prospective Studies;
Retrospective Studies;
Stroke
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2019;52(6):392-399
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: The surgical strategies for carotid endarterectomy (CEA) vary in terms of the anesthesia method, neurological monitoring, shunt usage, and closure technique, and no gold-standard procedure has been established yet. We aimed to analyze the feasibility and benefits of CEA under regional anesthesia (RA) and CEA under general anesthesia (GA).METHODS: Between June 2012 and December 2017, 65 patients who had undergone CEA were enrolled, and their medical records were prospectively collected and retrospectively reviewed. A total of 35 patients underwent CEA under RA with cervical plexus block, whereas 30 patients underwent CEA under GA. In the RA group, a carotid shunt was selectively used for patients who exhibited negative results on the awake test. In contrast, such a shunt was used for all patients in the GA group.RESULTS: There were no cases of postoperative stroke, cardiovascular events, or mortality. Nerve injuries were noted in 4 patients (3 in the RA group and 1 in the GA group), but they fully recovered prior to discharge. Operative time and clamp time were shorter in the RA group than in the GA group (119.29±27.71 min vs. 161.43±20.79 min, p<0.001; 30.57±6.80 min vs. 51.77±13.38 min, p<0.001, respectively). The hospital stay was shorter in the RA group than in the GA group (14.6±5.05 days vs. 18.97±8.92 days, p=0.022). None of the patients experienced a stroke or restenosis during the 27.23±20.3-month follow-up period.CONCLUSION: RA with a reliable awake test reduces shunt use and decreases the clamp and operative times of CEA, eventually resulting in a reduced length of hospital stay.
