Indications for General versus Local Anesthesia during Carotid Endarterectomy

Jan Mracek; Jakub Kletecka; Jan Mork; David Stepanek; Jiri Dostal; Jolana Mrackova; Vladimir Priban

doi:10.1055/s-0039-1678601

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2019; 80(04): 250-254
DOI: 10.1055/s-0039-1678601

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Indications for General versus Local Anesthesia during Carotid Endarterectomy

Jan Mracek

¹Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic

,

Jakub Kletecka

²Department of Anesthesia and Intensive Care Medicine, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic

,

Jan Mork

¹Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic

,

David Stepanek

¹Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic

,

Jiri Dostal

¹Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic

,

Jolana Mrackova

³Department of Neurology, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic

,

Vladimir Priban

¹Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic

› Author Affiliations

Abstract

Background and Study Aims Both general anesthesia (GA) and local anesthesia (LA) are used in our department for carotid endarterectomy. The decision of which anesthetic technique to use during surgery is made on an individual basis. The aim of our study was to analyze the reasons for using GA or LA.

Material and Methods The reasons that led to the selection of either GA or LA were analyzed retrospectively in a group of 409 patients.

Results GA was used in 304 patients (74%) and LA in 105 patients (26%). The reasons for a preference for GA were clopidogrel use (88 patients), patient preference (80), increased risk of shunt insertion (43), unfavorable anatomical conditions (41), surgeon preference (21), simultaneous carotid endarterectomy and cardiac surgery (18), emergent carotid endarterectomy (12), and sleep apnea syndrome (1). The reasons for selecting LA were internal comorbidities (46 patients), patient preference (39), unavailability of intraoperative electrophysiologic monitoring (15), and pacemaker (5).

Conclusion GA is the dominant choice for carotid endarterectomy in our department because of its prevailing benefits and its preference among neurosurgeons and patients. However, in some subgroups of patients, LA is preferable. An optimal approach is therefore an individual indication for both anesthesia techniques.

Keywords

carotid endarterectomy - general anesthesia - local anesthesia - indications

Full Text

References

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