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

Mustafa Çağdaş Çayır; Ahmet Yüksel

doi:10.28982/josam.703357

Authors

Mustafa Çağdaş Çayır Pamukkale Ünv. Tıp Fakültesi Kalp Damar Cerrahisi Anabilim Dalı https://orcid.org/0000-0002-9938-8599
Ahmet Yüksel https://orcid.org/0000-0003-0021-6509

DOI:

https://doi.org/10.28982/josam.703357

Keywords:

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

Abstract

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.

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References

Deser SB, Demirağ MK, Kolbakır F. Does severe contralateral carotid artery stenosis affect the outcomes of carotid endarterectomy? Turk Gogus Kalp Damar Cerrahisi Derg. 2019;27:35-42.

Deşer SB, Yucel SM, Demirag MK, Guclu MM, Kolbakir F, Keceligil HT. The association between platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and carotid artery stenosis and stroke following carotid endarterectomy. Vascular. 2019;27:604-11.

Deşer SB, Yucel SM, Demirag MK, Kolbakir F, Keceligil HT. Relationship of Inter-Arm Systolic Blood Pressure Difference with Subclavian Artery Stenosis and Vertebral Artery Stenosis in Patients Undergoing Carotid Endarterectomy. Braz J Cardiovasc Surg. 2019;34:136-41.

Deşer SB, Demirag MK, Kolbakir F. Does surgical technique influence the postoperative hemodynamic disturbances and neurological outcomes in carotid endarterectomy? Acta Chir Belg. 2019;119:78-82.

Nordanstig A, Rosengren L, Strömberg S. Editor's Choice - Very Urgent Carotid Endarterectomy is Associated with an Increased Procedural Risk: The Carotid Alarm Study. Eur J Vasc Endovasc Surg. 2017;54:278-86.

Bonifati DM, Lorenzi A, Ermani M, Refatti F, Gremes E, Boninsegna C, et al. Carotid stenosis as predictor of stroke after transient ischemic attacks. J Neurol Sci. 2011;303:85-9.

Öz K, Göde S, Onan B. Sliding arterioplasty: A novel technique for carotid endarterectomy. Turk J Vasc Surg. 2019;28:198-202.

Ladak N, Thompson J. General or local anaesthesia for carotid endarterectomy? Cont Ed in Anaesth Crit Care & Pain. 2012;12 (2):92-96. doi: 10.1093/bjaceaccp/mkr061

Spargo JR, Thomas D. Local anaesthesia for carotid endarterectomy. Cont Ed in Anaesth Crit Care & Pain. 2004; 4: 62–5. doi:doi.org/10.1093/bjaceaccp/mkh017

Yoldaş H, Karagöz İ. Effect of saline flush on the onset time of sugammadex: a randomized clinical study. J Surg Med. 2020;4:126-9.

Gomes M, Soares MO, Dumville JC, Lewis SC, Torgerson DJ, Bodenham AR, et al. Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery. Br J Surg. 2010;97:1218-25.

Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175-91.

Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421-8.

Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, et al. ESVS guidelines. Invasive treatment for carotid stenosis:indications, techniques. Eur J Vasc Endovasc Surg. 2009;37(4 Suppl):1-19.

Cheng MA, Theard MA, Tempelhoff R. Anesthesia for carotid endarterectomy: a survey. J Neurosurg Anesthesiol. 1997;9:211-6.

Modaghegh, M., Ravanbakhsh, M., Ghorbanian, E. Review of Post-Carotid Endarterectomy Complications. PSQI J. 2014;2:135-8.

Lobo M, Mourão J, Afonso G. Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal. Rev Bras Anestesiol. 2015;65:249-54.

Watts K, Lin PH, Bush RL, Awad S, McCoy SA, Felkai D, et al. The impact of anesthetic modality on the outcome of carotid endarterectomy. Am J Surg. 2004;188:741-7.

Lutz HJ, Michael R, Gahl B, Savolainen H.Local versus general anaesthesia for carotid endarterectomy--improving the gold standard? Eur J Vasc Endovasc Surg. 2008;36:145-9.

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

Gabelman CG, Gann DS, Ashworth CJ Jr, Carney WI Jr. One hundred consecutive carotid reconstructions: local versus general anesthesia. Am J Surg. 1983;145:477-82.

Kalko Y, Kafali E, Aydin U, Kafa U, Kosker T, Basaran M, et al. Surgery of the carotid artery: local anaesthesia versus general anaesthesia. Acta Chir Belg. 2007;107:53-7.

International Carotid Stenting Study investigators, Ederle J, Dobson J, Featherstone RL, Bonati LH, van der Worp HB, de Borst GJ, et al. Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial. Lancet. 2010;375:985-97.

Brott TG, Calvet D, Howard G, Gregson J, Algra A, Becquemin JP, et al. Long-term outcomes of stenting and endarterectomy for symptomatic carotid stenosis: a preplanned pooled analysis of individual patient data. Lancet Neurol. 2019;18:348-56. doi:

Toktas F, Goncu T, Surer S, Yumun G, Ozsin KK , Erdolu B, et al. Carotid endarterectomy: a comparison on general and local anesthesia. Eur Res J. 2015;1:39-43.

Markovic D, Vlajkovic G, Sindjelic R, Markovic D, Ladjevic N, Kalezic N. Cervical plexus block versus general anesthesia in carotid surgery: single center experience. Arch Med Sci. 2012;8:1035-40.

Sideso E, Walton J, Handa A. General or local anesthesia for carotid endarterectomy the-''real-world'' experience. Angiology. 2011;62:609-13.

Yümün G, Toktaş F, Ay D, Gücü A, Çayır MÇ, Türk T, et al. Effects of Anesthetic Technique on Arteriovenous Fistula Patency. Abant Med J. 2012;1:111-4.

Ferrero E, Ferri M, Viazzo A, Ferrero M, Gaggiano A, Berardi G, et al. Carotid endarterectomy: comparison between general and local anesthesia. Revision of our experience with 428 consecutive cases. Ann Vasc Surg. 2010;24:1034-7.

Saraç A, Jahollari A. Carotid endarterectomy under local anesthesia: An institutional report of experience.Turk J Vasc Surg. 2020;29(x):i-vi. (Ahead of print). DOI: 10.9739/tjvs.2020.632