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

Mustafa Çağdaş Çayır; Ahmet Yüksel

doi:10.28982/josam.703357

Research Article

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

Year 2020, , 195 - 198, 01.03.2020

Mustafa Çağdaş Çayır , Ahmet Yüksel

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

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.

Keywords

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

References

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. Öz K, Göde S, Onan B. Sliding arterioplasty: A novel technique for carotid endarterectomy. Turk J Vasc Surg. 2019;28:198-202.
8. 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
9. 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
10. 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.
11. 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.
12. 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.
13. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421-8.
14. 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.
15. Cheng MA, Theard MA, Tempelhoff R. Anesthesia for carotid endarterectomy: a survey. J Neurosurg Anesthesiol. 1997;9:211-6.
16. Modaghegh, M., Ravanbakhsh, M., Ghorbanian, E. Review of Post-Carotid Endarterectomy Complications. PSQI J. 2014;2:135-8.
17. 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.
18. 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.
19. 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.
20. 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.
21. 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.
22. 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.
23. 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.
24. 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:
25. 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.
26. 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.
27. Sideso E, Walton J, Handa A. General or local anesthesia for carotid endarterectomy the-''real-world'' experience. Angiology. 2011;62:609-13.
28. 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.
29. 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.
30. 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

Karotid endarterektomi için lokal veya genel anestezi: Hangi anestezi tekniği tercih edilmelidir?

Year 2020, , 195 - 198, 01.03.2020

Mustafa Çağdaş Çayır , Ahmet Yüksel

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

Abstract

Amaç: Karotid endarterektomi, karotid stenoz bulunan hastalarda sakatlığı veya ölümcül inmeyi engellemek için uygulanan bir prosedürdür. Bu çalışmanın amacı genel veya lokal anestezi teknikleri altında karotid endarterektomi uygulanan hastaları analiz ederek karşılaştırmak ve lokal anestezi yönteminin postoperatif morbidite ve mortalite açısından genel anesteziden daha üstün olup olmadığını belirlemektir.
Yöntemler: Kasım 2016 ve Ocak 2019 tarihleri arasında hastanemizin kardiyovasküler cerrahi kliniğinde ciddi karotid stenoz nedeniyle genel veya lokal anestezi altında karotid endarterektomi prosedürü uygulanan toplam 80 hasta bu prospektif kohort çalışmaya dahil edilmiştir. Prosedür 40 hastada genel ve 40 hastada lokal anestezi altında uygulanmıştır, ve çalışma grupları genel anestezi grubu ve lokal anestezi grubu olarak ikiye ayrıldı. İki grup sosyodemografik özellikler, preoperatif risk faktörleri, postoperatif komplikasyonlar, operasyon süresi ve hastanede kalış süresi açısından değerlendirilmiştir.
Bulgular: İki grup arasında yaş ve cinsiyet açısından anlamlı bir fark saptanmamıştır (sırasıyla P=0,665, P=0,636). Benzer şekilde genel anestezi ve lokal anestezi grupları arasında asemptomatik hastaların oranı, inme veya miyokard enfarktüsü insidansı açısından anlamlı fark saptanmamıştır (sırasıyla P=0,264, P=0,780, P=1,000). Postoperatif komplikasyonlardan minor strok (P=0,870), kraniyal sinir hasarı (P=0,870), hematom (P=1,000) ve internal karotis arter oklüzyonu (P=0,723) açısından iki group arasında anlamlı fark saptanmamıştır. Ortalama operasyon süresi ve hastanede kalış süresinin lokal anestezi grubunda genel anestezi grubuna kıyasla istatistiksel olarak anlamlı şekilde daha kısa olduğu saptanmıştır (sırasıyla P<0,001, P=0,655).
Sonuç: Lokal anestezi ile karotid endarterektomi prosedürü için daha kısa operasyon süresi ve hastanede kalış süresi saptanmıştır. Karotid endarterektomi prosedürü için lokal anestezi kullanımının yararlarını aydınlatmak amacıyla daha fazla kapsamlı prospektif çalışma gereklidir.

Keywords

Karotid endarterektomi, Lokal anestezi, Genel anestezi, Komplikasyonlar, Mortalite

References

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. Öz K, Göde S, Onan B. Sliding arterioplasty: A novel technique for carotid endarterectomy. Turk J Vasc Surg. 2019;28:198-202.
8. 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
9. 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
10. 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.
11. 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.
12. 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.
13. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421-8.
14. 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.
15. Cheng MA, Theard MA, Tempelhoff R. Anesthesia for carotid endarterectomy: a survey. J Neurosurg Anesthesiol. 1997;9:211-6.
16. Modaghegh, M., Ravanbakhsh, M., Ghorbanian, E. Review of Post-Carotid Endarterectomy Complications. PSQI J. 2014;2:135-8.
17. 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.
18. 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.
19. 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.
20. 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.
21. 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.
22. 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.
23. 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.
24. 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:
25. 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.
26. 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.
27. Sideso E, Walton J, Handa A. General or local anesthesia for carotid endarterectomy the-''real-world'' experience. Angiology. 2011;62:609-13.
28. 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.
29. 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.
30. 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

There are 30 citations in total.

Details

Primary Language	English
Subjects	Cardiovascular Surgery
Journal Section	Research article
Authors	Mustafa Çağdaş Çayır 0000-0002-9938-8599 Ahmet Yüksel This is me 0000-0003-0021-6509
Publication Date	March 1, 2020
Published in Issue	Year 2020

Cite

APA	Çayır, M. Ç., & Yüksel, A. (2020). Local or general anesthesia for carotid endarterectomy: Which anesthesia technique should be preferred?. Journal of Surgery and Medicine, 4(3), 195-198. https://doi.org/10.28982/josam.703357
AMA	Çayır MÇ, Yüksel A. Local or general anesthesia for carotid endarterectomy: Which anesthesia technique should be preferred?. J Surg Med. March 2020;4(3):195-198. doi:10.28982/josam.703357
Chicago	Çayır, Mustafa Çağdaş, and Ahmet Yüksel. “Local or General Anesthesia for Carotid Endarterectomy: Which Anesthesia Technique Should Be Preferred?”. Journal of Surgery and Medicine 4, no. 3 (March 2020): 195-98. https://doi.org/10.28982/josam.703357.
EndNote	Çayır MÇ, Yüksel A (March 1, 2020) Local or general anesthesia for carotid endarterectomy: Which anesthesia technique should be preferred?. Journal of Surgery and Medicine 4 3 195–198.
IEEE	M. Ç. Çayır and A. Yüksel, “Local or general anesthesia for carotid endarterectomy: Which anesthesia technique should be preferred?”, J Surg Med, vol. 4, no. 3, pp. 195–198, 2020, doi: 10.28982/josam.703357.
ISNAD	Çayır, Mustafa Çağdaş - Yüksel, Ahmet. “Local or General Anesthesia for Carotid Endarterectomy: Which Anesthesia Technique Should Be Preferred?”. Journal of Surgery and Medicine 4/3 (March 2020), 195-198. https://doi.org/10.28982/josam.703357.
JAMA	Çayır MÇ, Yüksel A. Local or general anesthesia for carotid endarterectomy: Which anesthesia technique should be preferred?. J Surg Med. 2020;4:195–198.
MLA	Çayır, Mustafa Çağdaş and Ahmet Yüksel. “Local or General Anesthesia for Carotid Endarterectomy: Which Anesthesia Technique Should Be Preferred?”. Journal of Surgery and Medicine, vol. 4, no. 3, 2020, pp. 195-8, doi:10.28982/josam.703357.
Vancouver	Çayır MÇ, Yüksel A. Local or general anesthesia for carotid endarterectomy: Which anesthesia technique should be preferred?. J Surg Med. 2020;4(3):195-8.

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