Anesthesia Technique Shows Benefits in Carotid Surgery
Cooperative patient approach allows advantages of local, general anesthesia during endarterectomy
THURSDAY, June 11 (HealthDay News) -- An anesthesia approach called cooperative patient general anesthesia allows neurological monitoring plus safe airway control during carotid endarterectomy, according to research published in the June issue of Anesthesia & Analgesia.
Sergio Bevilacqua, M.D., of the Azienda Ospedaliera Universitaria Careggi in Firenze, Italy, and colleagues analyzed data from 181 patients, with a mean age 73.5 years, undergoing carotid endarterectomy. The researchers used remifentanil and propofol and reduced the anesthesia during carotid clamping to allow the patient to respond to verbal commands and allow neurological monitoring. Patients had tracheal intubation.
This technique was performed on all but two patients, who were converted to general anesthesia during carotid clamping due to agitation. No postoperative neurological events were noted. The researchers found that 19.34 percent perceived time passing while conscious and 98.8 percent reported that they were satisfied or very satisfied with the anesthesia, and most surgeons (93.92 percent) were very satisfied.
"This technique of anesthesia is characterized by hemodynamic stability and absolute control of ventilatory pattern. Continuous clinical neurological monitoring is achieved allowing early and specific detection of cerebral hypoperfusion and the easy, prompt and safe conversion to general anesthesia whenever required, particularly in those cases in which carotid shunt placement does not reverse neurological symptoms. In our series, no neurological deficit occurred and the incidence of major cardiac complications was comparable to that previously reported in the literature," the authors write.