General Anesthesia For Carotid Endarterectomy Research Articles

Nasal Intubation is not Associated with “Smoother” Emergence from General Anesthesia for Carotid Endarterectomy: A Case-Cohort Study

Postoperative hematoma after carotid endarterectomy (CEA) is a devastating complication and may be more likely in patients with uncontrolled hypertension and coughing on emergence from anesthesia. We sought to determine if intubation with a nasal endotracheal tube (ETT)-instead of an oral ETT-is associated with "smoother" (i.e., less hemodynamic instability) emergence from general anesthesia for CEA. Patients receiving CEA between December 2015 and September 2021 at a single tertiary academic medical center were included. We examined the electronic anesthesia records for 323 patients who underwent CEA during the 6-year study period and recorded consecutive systolic blood pressure (SBP) values during the 10minutes before extubation as a surrogate for "smoothness" of the emergence. Intubation with a nasal ETT, when compared with intubation with an oral ETT, was not associated with any difference in maximum, minimum, average, median, or standard deviation of serial SBP values in the 10minutes before extubation. The average SBP on emergence for patients with an oral ETT was 141mm Hg and with a nasal ETT was 144mm Hg (P=0.562). The maximum SBP for patients with oral and nasal ETTs were 170mm Hg and 174mm Hg, respectively (P=0.491). There were also no differences in the qualitative "smoothness" of emergence or in the percentage of patients who required an intravenous dose of 1 or more antihypertensive medications. The incidence of postoperative complications was similar between the 2 groups. When SBP is used as a surrogate for smoothness of emergence from general anesthesia for CEA, intubation with a nasal ETT was not associated with better hemodynamic stability compared to intubation with an oral ETT.

Effect of remimazolam versus propofol for the induction of general anesthesia on cerebral blood flow and oxygen saturation in elderly patients undergoing carotid endarterectomy

BackgroundThis study was conducted to investigate the effects and safety of remimazolam versus propofol on cerebral oxygen saturation and cerebral hemodynamics during the induction of general anesthesia in patients receiving carotid endarterectomy (CEA), so as to provide theoretical basis for better clinical application of remimazolam.MethodsForty-three patients (60–75 years old) with carotid artery stenosis (carotid artery stenosis greater than 70%) were randomly divided into the remimazolam group (R group) and the propofol group (P group). Anesthesia was induced with remimazolam (0.3 mg/kg) or propofol (1.5-2 mg/kg) individually. At time of admission (T0), post-anesthesia induction (T1), consciousness disappears (T2), 1 min after loss of consciousness (T3), 2 min after loss of consciousness (T4) and pre-endotracheal intubation (T5), measurement in patients with regional cerebral oxygen saturation (SrO2), average blood flow velocity (Vm), resistance index (RI), mean arterial pressure (MAP), heart rate (HR) and cardiac index (CI) were recorded.ResultsSrO2 increased significantly in both groups after induction of anesthesia compared with baseline (P < 0.05) and decreased after loss of consciousness (P < 0.05). There was no difference in the mean value of the relative changes in SrO2 between the groups. Meanwhile, the Vm, RI, HR and CI of each time point between two groups showed no statistically significant difference (P > 0.05) while MAP in group P at T5 was lower than that in group R individually(P < 0.05). In each group, Vm, HR, CI and MAP at T2-T5 were all significantly reduced compared with T1, with statistically differences(P < 0.05). Specifically, there was no difference of RI at each time between or within groups(P > 0.05).ConclusionsOur study revealed that remimazolam can be administered safely and effectively during the induction of general anesthesia for carotid endarterectomy in elder population and it demonstrated superiority in hemodynamic changes compared with propofol.Clinical trial registrationThis trial was retrospectively registered with the Chinese Clinical Trial Registry. Registration number: ChiCTR2300070370. Date of registration: April 11, 2023.

Effect of Vitamin C Infusion on Cerebral Oximetry During General Anesthesia for Carotid Endarterectomy in Diabetic Patients.

There is conflicting information about the effect of vitamin C on brain oxygenation during anesthesia. The current study was designed and performed to assess the effect of vitamin C infusion and brain oxygenation with cerebral oximetry on improving brain perfusion during general anesthesia in vascular surgery of diabetic patients. This randomized clinical trial was performed on patients candidates for endarterectomy under general anesthesia and referred to Taleghani Hospital in Tehran, Iran, during 2019 - 2020. Considering inclusion criteria, the patients were divided into placebo and intervention groups. The patients in the placebo group received 500 mL of isotonic saline. In the intervention group, the patients received 1 g of vitamin C diluted in 500 mL of isotonic saline by infusion half an hour before anesthesia induction. Patients' oxygen levels were continuously measured by a cerebral oximetry sensor. The patients were put in a supine position for 10 minutes before and after anesthesia. At the end of the surgery, the indicators considered in the study were evaluated. No considerable difference was observed between systolic and diastolic blood pressure, heart rate, mean arterial pressure, partial pressure of carbon dioxide, oxygen saturation, regional oxygen saturation, supercritical carbon dioxide, and end-tidal carbon dioxide in total and between the two groups in the three stages before and after anesthesia induction and at the end of surgery (P > 0.05). Additionally, there was no significant difference between blood sugar (BS) levels in the study groups (P > 0.05) but in BS levels at three stages before and after anesthesia induction and at the end of the surgery, with a significant difference (P < 0.05). The amount of perfusion in the two groups and, therefore, in total at the three stages before and after anesthesia induction and at the end of surgery is not different.

Local versus general anaesthesia for carotid endarterectomy.

Carotid endarterectomy may significantly reduce the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant perioperative risks that may be minimised by performing the operation under local rather than general anaesthetics. This is an update of a Cochrane Review first published in 1996, and previously updated in 2004, 2008, and 2013. To determine whether carotid endarterectomy under local anaesthetic: 1) reduces the risk of perioperative stroke and death compared with general anaesthetic; 2) reduces the complication rate (other than stroke) following carotid endarterectomy; and 3) is acceptable to individuals and surgeons. We searched CENTRAL, MEDLINE, Embase, and two trials registers (to February 2021). We also reviewed reference lists of articles identified. Randomised controlled trials (RCTs) comparing the use of local anaesthetics to general anaesthetics for people having carotid endarterectomy were eligible. Three review authors independently extracted data, assessed risk of bias, and evaluated quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool. We calculated a pooled Peto odds ratio (OR) and corresponding 95% confidence interval (CI) for the following outcomes that occurred within 30 days of surgery: stroke, death, ipsilateral stroke, stroke or death, myocardial infarction, local haemorrhage, and arteries shunted. We included 16 RCTs involving 4839 participants, of which 3526 were obtained from the single largest trial (GALA). The main findings from our meta-analysis showed that, within 30 days of operation, neither incidence of stroke nor death were significantly different between local and general anaesthesia. Of these, the incidence of stroke in the local and general anaesthesia groups was 3.2% and 3.5%, respectively (Peto odds ratio (OR) 0.91, 95% confidence interval (CI) 0.66 to 1.26; P = 0.58; 13 studies, 4663 participants; low-quality evidence). The rate of ipsilateral stroke under both types of anaesthesia was 3.1% (Peto OR 1.03, 95% CI 0.71 to 1.48; P = 0.89; 2 studies, 3733 participants; low-quality evidence). The incidence of stroke or death in the local anaesthesia group was 3.5%, while stroke or death incidence was 4.1% in the general anaesthesia group (Peto OR 0.85, 95% CI 0.62 to 1.16; P = 0.31; 11 studies, 4391 participants; low-quality evidence). A lower rate of death was observed in the local anaesthetic group but evidence was of low quality (Peto OR 0.61, 95% CI 0.35 to 1.06; P = 0.08; 12 studies, 4421 participants). The incidence of stroke and death were not convincingly different between local and general anaesthesia for people undergoing carotid endarterectomy. The current evidence supports the choice of either approach. Further high-quality studies are still needed as the evidence is of limited reliability.

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.

General vs Local Anesthesia and Completion Angiography Findings After Carotid Endarterectomy

Introduction: To assess the differences of completion angiography after carotid endarterectomy between local and general anesthetic approach. Our secondary outcomes were to evaluate the relationship between intraoperative reparations and postoperative strokes; and to assess the usefulness of external carotid reparation when it was occluded during the procedure. Methods: A prospective study from January 2003 to January 2019 was performed including 1470 consecutive patients having 1559 carotid endarterectomies. Exclusion criteria were patients with allergy to contrast media. In our cohort, the surgical technique performed was carotid endarterectomy with patch in 96,95% of cases and carotid eversion in 3,05% of patients. 42,8% of them were asymptomatic, 11,4% had a stroke and 45,8% had a transient ischemic attack. Angiography was performed on 1289 cases. Findings included stenosis of common, external or internal carotid artery, occlusion of external carotid artery and intimal flap or intraluminal filling defect on internal carotid artery. The decision to repair the defect was based on the consensus of the surgical team. Intrahospitalary stroke rate was recorded. Categorical data were analyzed by the chi-square test and continuous data were expressed as mean standard deviation, median and interquartile range. Results: Comparing both anesthetic groups, we found more angiographic defects on the general anesthetic group (236 patients (22%)) than in the local anesthetic group (35 patients (13,7%))(p = 0.001) and more shunt need (42,2% vs 23,3% p = 0,001) but it did not result in more stroke rates (2,8% vs 1,9% p = 0.57). Of those 271 defects, 174 affected the common or internal carotid artery, and 45 were suitable for reparation (26% in general anesthesia group vs 25% in local anesthesia group (p = 0.9)). Postoperative strokes were similar among patients who underwent reparation or not (0% vs 3,9% p = 0.18). We found 64 external carotid occlusions. 37 of them underwent reparation, without differences among postoperative stroke rates (3,6% vs 2,8% p = 0.85). Conclusion: Patients under general anesthesia for carotid endarterectomy have more postoperative angiographic defects, but its reparation does not seem to affect postoperative stroke rate. External carotid artery repair may not be clinically relevant. Disclosure: Nothing to disclose

Meta-analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy.

Controversy exists regarding the best choice of anaesthesia for carotid endarterectomy. We aimed to evaluate the peri-operative outcomes of local vs. general anaesthesia for carotid endarterectomy. We conducted a systematic search of electronic information sources and applied a combination of free text and controlled vocabulary searches adapted to thesaurus headings, search operators and limits in each of the electronic databases. We defined peri-operative stroke, transient ischaemic attack, mortality and myocardial infarction as the primary outcome measures. We identified 12 randomised controlled trials and 21 observational studies reporting a total of 58,212 patients undergoing carotid endarterectomy under local or general anaesthesia. Analysis of observational studies demonstrated that local anaesthesia was associated with a significantly lower incidence of stroke (odds ratio (OR (95% CI) 0.66 (0.55-0.80), p<0.0001), transient ischaemic attack (0.52 (0.38-0.70), p<0.0001), myocardial infarction (0.55 (0.41-0.75), p=0.0002) and mortality (0.72 (0.56-0.94), p=0.01) compared with general anaesthesia. Analysis of randomised controlled trials did not find a significant difference in the risk of stroke (0.92 (0.67-1.28), p=0.63), transient ischaemic attack (2.20 (0.48-10.03), p=0.31), myocardial infarction (1.25 (0.57-2.72), p=0.58) or mortality (0.61 (0.35-1.05), p=0.07) between local and general anaesthesia. On trial sequential analysis of the randomised trials, the Z-curve did not cross the α-spending boundaries or futility boundaries for stroke, mortality and transient ischaemic attack, suggesting that more trials are needed to reach conclusive results. Our meta-analysis of observational studies suggests that local anaesthesia for carotid endarterectomy may be associated with lower peri-operative morbidity and mortality compared with general anaesthesia. Although randomised studies have not confirmed any advantage for local anaesthesia, this may be due to a lack of pooled statistical power in these trials.

Ultrasound-guided superficial cervical plexus block under dexmedetomidine sedation versus general anesthesia for carotid endarterectomy: a retrospective pilot study.

BackgroundCarotid endarterectomy (CEA) has been performed under regional and general anesthesia (GA). The general anesthesia versus local anesthesia for carotid surgery study compared the two techniques and concluded that there was no difference in perioperative outcomes. However, since this trial, new sedative agents have been introduced and devices that improve the delivery of regional anesthesia (RA) have been developed. The primary purpose of this pilot study was to compare intraoperative hemodynamic stability and postoperative outcomes between GA and ultrasound-guided superficial cervical plexus block (UGSCPB) under dexmedetomidine sedation for CEA.MethodsMedical records from 43 adult patients who underwent CEA were retrospectively reviewed, including 16 in the GA group and 27 in the RA group. GA was induced with propofol and maintained with sevoflurane. The UGSCPB was performed with ropivacaine under dexmedetomidine sedation. We compared the intraoperative requirement for vasoactive drugs, postoperative complications, pain scores using the numerical rating scale, and the duration of hospital stay.ResultsThere was no difference between groups in the use of intraoperative antihypertensive drugs. However, intraoperative inotropic and vasopressor agents were more frequently required in the GA group (p<0.0001). In the GA group, pain scores were significantly higher during the first 24 h after surgery (p<0.0001 between 0-6 h, p<0.004 between 6-12 h, and p<0.001 between 12-24 h). The duration of hospital stay was significantly more in the GA group (13.3±4.6 days in the GA group vs. 8.5±2.4 days in the RA group, p<0.001).ConclusionIn this pilot study, intraoperative hemodynamic stability and postoperative outcomes were better in the RA compared to the GA group.

A Cost Analysis of Regional Versus General Anesthesia for Carotid Endarterectomy

Medical care in the United States has evolved into a more cost-conscious value-based health care system that necessitates a comparison of costs when there are alternative interventions considered to be acceptable in the treatment of a disease. This study compares the cost differences between regional anesthesia (RA) and general anesthesia (GA) for carotid endarterectomy (CEA). Data from 346 consecutive patients who underwent CEA between January 2012 and September 2014 were retrospectively reviewed for the type of anesthesia used, outcomes data, and cost variables. Overall hospital day costs were compared between RA and GA. Medians and interquartile ranges were compared using Wilcoxon-Mann-Whitney test. A P<0.05 was considered statistically significant using 2-sided tests. Median overall costs for GA were significantly higher than median costs for RA (medians [with interquartile ranges], $10,140 [$7,158-$12,658] versus $7,122 [$5,072-$8,511], P<0.001). Median total operative time for GA was significantly longer than median time for RA (168 [144-188] versus 134 [115-147] min, P<0.001). Median in-hospital length of stay (LOS) for GA was significantly longer compared with RA (2.0 vs 1.2days, P<0.001). Patients who received GA were also more likely to be admitted to the intensive care unit. Decreased cost, operating room expenses, postoperative resources, and overall LOS were observed for individuals who underwent RA for CEA as compared with GA. In summary, RA is more cost-effective and should be the optimal choice when clinically appropriate.

A Cost-Effective Analysis Comparing Regional to General Anesthesia for Carotid Endarterectomy

A Cost-Effective Analysis Comparing Regional to General Anesthesia for Carotid Endarterectomy

Local Versus General Anaesthesia for Carotid Endarterectomy

Carotid endarterectomy (CEA) is the most frequently performed noncardiac vascular procedure. CEA reduces the rate of stroke in people with symptomatic stenosis however, benefit requires a low operative risk, which may depend on the type of anesthetic used.

Local versus general anaesthesia for carotid endarterectomy

Carotid endarterectomy may significantly reduce the risk of stroke in people with recently symptomatic, severe carotid artery stenosis. However, there are significant perioperative risks that may be reduced by performing the operation under local rather than general anaesthetic. This is an update of a Cochrane Review first published in 1996, and previously updated in 2004 and 2008. To determine whether carotid endarterectomy under local anaesthetic: (1) reduces the risk of perioperative stroke and death compared with general anaesthetic; (2) reduces the complication rate (other than stroke) following carotid endarterectomy; and (3) is acceptable to patients and surgeons. We searched the Cochrane Stroke Group Trials Register (September 2013), MEDLINE (1966 to September 2013), EMBASE (1980 to September 2013) and Index to Scientific and Technical Proceedings (ISTP) (1980 to September 2013). We also handsearched relevant journals, and searched the reference lists of articles identified. Randomised trials comparing the use of local anaesthetic to general anaesthetic for carotid endarterectomy were considered for inclusion. Three review authors independently assessed trial quality and extracted data. We calculated a pooled Peto odds ratio (OR) and corresponding 95% confidence interval (CI) for the following outcomes that occurred within 30 days of surgery: stroke, death, stroke or death, myocardial infarction, local haemorrhage, cranial nerve injuries, and shunted arteries. We included 14 randomised trials involving 4596 operations, of which 3526 were from the single largest trial (GALA). In general, reporting of methodology in the included studies was poor. All studies were unable to blind patients and surgical teams to randomised treatment allocation and for most studies the blinding of outcome assessors was unclear. There was no statistically significant difference in the incidence of stroke within 30 days of surgery between the local anaesthesia group and the general anaesthesia group. The incidence of strokes in the local anaesthesia group was 3.2% compared to 3.5% in the general anaesthesia group (Peto OR 0.92, 95% CI 0.67 to 1.28). There was no statistically significant difference in the proportion of patients who had a stroke or died within 30 days of surgery. In the local anaesthesia group 3.6% of patients had a stroke or died compared to 4.2% of patients in the general anaesthesia group (Peto OR 0.85, 95% CI 0.63 to 1.16). There was a non-significant trend towards lower operative mortality with local anaesthetic. In the local anaesthesia group 0.9% of patients died within 30 days of surgery compared to 1.5% of patients in the general anaesthesia group (Peto OR 0.62, 95% CI 0.36 to 1.07). However, neither the GALA trial or the pooled analysis were adequately powered to reliably detect an effect on mortality. The proportion of patients who had a stroke or died within 30 days of surgery did not differ significantly between the two types of anaesthetic techniques used during carotid endarterectomy. This systematic review provides evidence to suggest that patients and surgeons can choose either anaesthetic technique, depending on the clinical situation and their own preferences.

Regional Versus General Anesthesia for Carotid Endarterectomy: The American College of Surgeons National Surgical Quality Improvement Program Perspective

Background The ideal anesthetic technique for carotid endarterectomy remains a matter of debate. This study used the American College of Surgeons National Surgical Quality Improvement Program to evaluate the influence of anesthesia modality on outcomes after carotid endarterectomy. Methods Postoperative outcomes were compared for American College of Surgeons National Surgical Quality Improvement Program patients undergoing carotid endarterectomy between 2005 and 2009 with either general or regional anesthesia. A separate analysis was performed on a subset of patients matched on propensity for undergoing carotid endarterectomy with regional anesthesia. Results For the entire sample of 24,716 National Surgical Quality Improvement Program patients undergoing carotid endarterectomy and the propensity-matched cohort of 8,050 patients, there was no difference in the 30-day postoperative composite stroke/myocardial infarction/death rate based on anesthetic type. Within the matched cohort, the rate of other complications did not differ (2.8% regional vs 3.6% general anesthesia; P = .07), but patients receiving regional anesthesia had shorter operative (99 ± 36 minutes vs 119 ± 53 minutes; P P P Conclusion Anesthesia technique does not impact patient outcomes after carotid endarterectomy, but may influence overall cost of care.

Regional versus general anesthesia for carotid endarterectomy: The American College of Surgeons National Surgical Quality Improvement Program perspective

The ideal anesthetic technique for carotid endarterectomy remains a matter of debate. This study used the American College of Surgeons National Surgical Quality Improvement Program to evaluate the influence of anesthesia modality on outcomes after carotid endarterectomy. Postoperative outcomes were compared for American College of Surgeons National Surgical Quality Improvement Program patients undergoing carotid endarterectomy between 2005 and 2009 with either general or regional anesthesia. A separate analysis was performed on a subset of patients matched on propensity for undergoing carotid endarterectomy with regional anesthesia. For the entire sample of 24,716 National Surgical Quality Improvement Program patients undergoing carotid endarterectomy and the propensity-matched cohort of 8,050 patients, there was no difference in the 30-day postoperative composite stroke/myocardial infarction/death rate based on anesthetic type. Within the matched cohort, the rate of other complications did not differ (2.8% regional vs. 3.6% general anesthesia; P = .07), but patients receiving regional anesthesia had shorter operative (99 ± 36 minutes vs 119 ± 53 minutes; P < .0001) and anesthesia times (52 ± 29 minutes vs. 64 ± 37 minutes; P < .0001) and were more likely to be discharged the next day (77.0% vs 64.4%; P < .0001). Anesthesia technique does not impact patient outcomes after carotid endarterectomy, but may influence overall cost of care.

Outcomes of carotid endarterectomy under general and regional anesthesia from the American College of Surgeons' National Surgical Quality Improvement Program

Despite multiple studies over more than 3 decades, there still is no consensus about the influence of anesthesia type on postoperative outcomes following carotid endarterectomy (CEA). The objective of this study was to investigate whether anesthesia type, either general anesthesia (GA) or regional anesthesia (RA), independently contributes to the risk of postoperative cardiovascular complications or death using the American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) database. Retrospective analysis of elective cases of CEA from 2005 through 2009 was performed. A propensity score model using 45 covariates, including demographic factors, comorbidities, stroke history, measures of general health, and laboratory values, was used to adjust for bias and to determine the independent influence of anesthesia type on postoperative stroke, myocardial infarction (MI), and death. Of 26,070 cases listed in the ACS NSQIP database, GA and RA were used in 22,054 (84.6%) and 4016 (15.4%) cases, respectively. Postoperative stroke, MI, and death occurred in 360 (1.63%), 133 (0.6%), and 154 (0.70%) patients of the GA group, respectively, and in 58 (1.44%), 11 (0.27%), and 27 (0.67%) patients of the RA group, respectively. Stratification by propensity score quintile and adjustment for covariates demonstrated GA to be a significant risk factor for postoperative MI with an adjusted odds ratio (OR) and confidence interval (CI) of 2.18 (95% CI, 1.17-4.04), P = .01 in the entire study population. The OR for MI was 5.41 (95% CI, 1.32-22.16; P = .019) in the subgroup of patients with preoperative neurologic symptoms, and 1.44 (95% CI, 0.71-2.90; P = .31) in the subgroup of patients without preoperative neurologic symptoms. This analysis of a large, prospectively collected and validated multicenter database indicates that GA for CEA is an independent risk factor for postoperative MI, particularly in patients with preoperative neurologic symptoms.

Comparison Between Local and General Anesthesia for Carotid Endarterectomy: Early and Late Results

The aim of this retrospective study was to compare the results between general and local anesthesia (LA) for carotid endarterectomy (CEA). Three hundred and twenty-nine patients in whom 365 CEA procedures were performed between January 1990 and September 2001, were included in this study. Operation time, shunt usage rates, hospitalization time (P < .0001), and permanent stroke rates (P < .05) were significantly lower in group with LA. For long-term period (121.3 ± 37.45 vs 98.6 ± 28.98 months), no significant difference was observed in these 2 group with respect to restenosis rates, neurological events, and deaths. Despite the lack of significant difference between LA and general anesthesia in terms of restenosis, neurological events, and death in the long-term period; LA is more preferable due its associated advantages including availability of testing the consciousness of the patients by direct contact, reduced use of shunts, shorter hospitalization periods, and less prevalence of permanent stroke in the short-term period.

Local Versus General Anesthesia for Carotid Endarterectomy

Like the earlier multicenter General Anesthesia (GA) versus Local Anaesthesia (LA) for carotid surgery (GALA) trial, a recent independent study showed no difference in transient ischemic attack, stroke, myocardial infarction, and death rates between carotid endarterectomy (CEA) performed under LA compared with GA. Besides these outcomes, however, several additional issues may be of interest when comparing the 2 modalities. Examples include the occurrence of post-CEA patient delirium, cognitive dysfunction, and health-related quality of life, as well as the cost-effectiveness, length of hospitalization, and resource utilization. This commentary discusses and compares these outcomes of CEA performed under LA versus GA.

PP2. Patient Cooperation During General Anesthesia for Carotid Endarterectomy. A Third Anesthetic Option

PP2. Patient Cooperation During General Anesthesia for Carotid Endarterectomy. A Third Anesthetic Option

472: Regional Block Anaesthesia vs General Anaesthesia for Carotid Endarterectomy

472: Regional Block Anaesthesia vs General Anaesthesia for Carotid Endarterectomy

Regional Block Anaesthesia vs General Anaesthesia for Carotid Endarterectomy

Regional Block Anaesthesia vs General Anaesthesia for Carotid Endarterectomy