Carotid endarterectomy: a comparison on general and local anesthesia

Year 2015, Volume: 1 Issue: 2, 39 - 43, 04.07.2015

Faruk Toktas , Tugrul Goncu Suleyman Surer , Gunduz Yumun , Kadir Ozsin , Burak Erdolu Senol Yavuz , Arif Gucu

https://doi.org/10.18621/eurj.2015.1.2.39

Cited By: 3

Abstract

Objective. Carotid endarterectomy (CEA) reduces disabling or fatal stroke risk in patients with significant carotid stenosis. The aim of this study was to compare the results of CEA performed under general anesthesia (GA) or local anesthesia (LA) in patients with symptomatic severe carotid artery stenosis. Method. We retrospectively collected the data on 64 patients who underwent CEA under GA (47 patients) and LA (17 patients) at our hospital from January 2010 to January 2014. All clinical, demographics, preoperative risk factors and postoperative data were compared for postoperative results. Surgical indications, techniques, and complications were also compared. Results. The groups were similar for age, gender and preoperative risk factors. There were no significant differences in death (GA: 4.2% vs. LA: 0%; p =1.0), stroke (GA: 4.2% vs. LA: 0%; p=1.0), death/ stroke rate (GA: 2.1% vs. LA: 0%; p=1.0), nerve injury (GA: 2.1% vs. LA: 5.8%; p=0.464), saphenous vein patch closure (GA: 83% vs. LA: 59%; p=0.051), shunt rate (GA: 8.5% vs. LA: 6 %; p=1.0), hospital stay (GA: 8.2±5.7 day vs. LA: 6.2±2.9 day, p=0.275), hematoma rate (GA: 0 %vs. LA: 5.8%; p =0.266) and transient ischemic attack rate (GA: 4.2% vs. LA: 0%; p=1.0) between the two techniques. Mortality occurred in two patients (both in the GA group) due to stroke and myocardial infarction. Conclusion. Carotid endarterectomy performed safely under general or local anesthesia is associated with low morbidity and mortality rates. Local anesthesia can be a safe option for evaluating the better neurological status during operation.

Keywords

Carotid endarterectomy, general anesthesia, local anesthesia, carotid artery stenosis

References

• Tangkanakul C, Counsell C, Warlow C. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev. 2000;(2):CD000126.
• GALA Trial Collaborative Group, Lewis SC, Warlow CP, Bodenham AR, Colam B, Rothwell PM, Torgerson D, et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet. 2008 Dec 20;372(9656):2132-42.
• 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 Aug;36(2):145-9; discussion 150-1.
• Hidiroglu M, Cetin L, Kunt A, Karakisi O, Kucuker A, Sener E. Early results of carotid endarterectomy for carotid artery diseases. Turk Gogus Kalp Dama. 2010;18(3):190-5.
• Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, et al; ESVS Guidelines Collaborators. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg. 2009 Apr;37(4 Suppl):1-19.
• Gurer O, Yapici F, Yapici N, Ozler A, Isik O. Comparison between local and general anesthesia for carotid endarterectomy: early and late results. Vasc Endovasc Surg. 2012 Feb;46(2):131-8.
• 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 Belgica. 2007 Jan-Feb;107(1):53-7.
• McCarthy RJ, Walker R, McAteer P, Budd JS, Horrocks M. Patient and hospital benefits of local anaesthesia for carotid endarterectomy. Eur J Vasc Endovasc Surg. 2001 Jul;22(1):13-8.
• Surer S, Yay K, Camkiran A, Bekmezcil M, Darcin OT. Carotid endarterectomy with local anaesthesia in patients with advanced age and chronic obstructive pulmonary disease: early term results. Turk J Geriatr. 2013;16(4):372-5.
• Halm EA, Hannan EL, Rojas M, Tuhrim S, Riles TS, Rockman CB, et al. Clinical and operative predictors of outcomes of carotid endarterectomy. J Vasc Surg. 2005 Sep;42(3):420-8.
• Stoner MC, Abbott WM, Wong DR, Hua HT, Lamuraglia GM, Kwolek CJ, et al. Defining the high-risk patient for carotid endarterectomy: an analysis of the prospective National Surgical Quality Improvement Program database. J Vasc Surg. 2006 Feb;43(2):285-95;discussion 295-6.
• Rerkasem K, Rothwell PM. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD000126.
• 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 Dec;8(6):1035-40.
• Sideso E, Walton J, Handa A. General or local anesthesia for carotid endarterectomy—the ‘‘real-world’’ experience. Angiology. 2011 Nov;62(8):609-13.
• Schechter MA, Shortell CK, Scarborough JE. Regional versus general anesthesia for carotid endarterectomy: the American College of Surgeons National Surgical Quality Improvement Program perspective. Surgery. 2012 Sep;152(3):309-14.
• Gensare B, Angelis l, Weingartner J, Neumaier-Prauser P, Spiliopoulos K, Kemkes BM. Simultaneous carotid endarterectomy and cardiac surgery--additional risk factor or safety procedure? Thorac Cardiovasc Surg. 2003 Feb;51(1):22-7.
• Yildirim T, Akgun S, Sur H, Kinikoglu H, Bilgin F, Arsan S. Short-term results of simultaneous carotid endarterectomy and myocardial revascularization. Turk Gogus Kalp Dama. 2004;12(3):156-60.
• 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 Nov;24(8):1034-7.
• Watts K, Lin PH, Bush RL, Awad S, McCoy S, Felkai D, et al. The impact of anesthetic modality on the outcome of carotid endarterectomy. Am J Surg. 2004 Dec;188(6):741-7.
• 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 Nov;35(4):232-8.