Outcomes of Dexmedetomidine with Local Regional Anesthesia in Carotid Endarterectomy

Abstract

Adequate sedation to complement regional techniques in carotid endarterectomy (CEA) can be challenging. Dexmedetomidine has both analgesic and amnesic properties and is reported to be a safe and acceptable alternative to conventional general endotracheal anesthesia (GETA). Outcomes observing dexmedetomidine in conjunction with regional anesthesia in CEA are not well described or known. Compare the immediate (during hospitalization) and short-term (within 30days of hospitalization) postoperative outcomes in patients who underwent CEA using GETA versus local regional anesthesia (LRA) alone versus dexmedetomidine with LRA at a single institution to determine whether dexmedetomidine is a safe adjunct and if there are anesthesia advantages over LRA alone. A retrospective cohort study from January 2015 to December 2019 at Saint Joseph Mercy Ann Arbor. Patients were stratified into three groups based on anesthesia type: GETA, LRA, and dexmedetomidine (D) + LRA. Primary outcomes included stroke, myocardial infarction (MI), and death. Patient demographics were characterized and adjusted using propensity score weighting. Three hundred seventy nine patients met inclusion criteria; 182 patients in the GETA group, 66 in the D+LRA, and 131 in LRA. There were no significant differences across anesthesia groups in primary outcomes of stroke, MI, and death during the admission. The GETA group had significantly longer length of stay (LOS) compared to the D+LRA group (LOS=1.51days versus 0.85days; P=0.011) and the LRA group (LOS=1.08days; P=0.003). However, there was no significant difference in hospital LOS between the D+LRA group and LRA only groups (P=0.952). There was no significant difference between stroke (LRA 0.87%, GETA 0.85%, and LRA+Dex 3.52%), MI (LRA 0%, GETA 0.49%, LRA+Dex 0%), or death (LRA 5.24%, GETA 1.16%, LRA+Dex 0%), within 30days between all three of the anesthesia groups. There was no significant difference in postoperative pain scores when comparing the GETA group (mean 1.3, standard deviation [SD] 2.5) to LRA (mean 1.2, SD 2.1) and between LRA and D+LRA (mean 0.9, SD 2.1). Procedure time (time of skin incision to closure) and total room time were comparable among all three anesthesia groups (LRA 2.2hr, SD 2.2; GETA 2.1hr, SD 0.5; LRA+Dex 2.1hr, SD 0.5). The use of dexmedetomidine in addition to LRA is a safe and acceptable alternative to conventional GETA or LRA alone in CEA with shorter length of hospital stay when compared with GETA, improved patient tolerance based on physician observation, and similar rates of immediate and short-term complications and postoperative pain scores.