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Carotid endarterectomy under regional anesthesia
1Faculdade de Ciências Médicas de Minas Gerais, Santa Casa de Belo Horizonte, Minas Gerais, Brasil.
Neurologia Medico-Chirurgica
|May 11, 1999
Summary
Regional anesthesia for carotid endarterectomy is a safe and effective technique. This method allows for real-time neurological assessment, improving patient outcomes and enabling surgery for high-risk individuals.
Area of Science:
- Neurosurgery
- Anesthesiology
- Vascular Surgery
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- General anesthesia poses risks for patients with comorbidities.
- Regional anesthesia offers an alternative for patient selection and monitoring.
Purpose of the Study:
- To evaluate the safety and efficacy of regional anesthesia for carotid endarterectomy.
- To assess the utility of regional anesthesia in monitoring neurological status during the procedure.
- To determine the morbidity and mortality rates associated with this technique.
Main Methods:
- A series of 180 patients undergoing carotid endarterectomy between May 1990 and December 1995.
- Regional anesthesia utilizing a deep cervical plexus block (C-4 level) and superficial block.
- Microsurgical technique with intraoperative neurological assessment of awake patients during carotid cross-clamping.
Main Results:
- 198 consecutive endarterectomies performed (10% bilateral).
- Total morbidity-mortality rate of 2.0% in 180 patients.
- Regional anesthesia facilitated accurate assessment of shunt necessity via neurological monitoring.
Conclusions:
- Regional anesthesia is a simple, reliable, and safe technique for carotid endarterectomy.
- It is particularly beneficial for patients with cardiac or pulmonary conditions unsuitable for general anesthesia.
- This approach allows for precise intraoperative decision-making regarding shunting based on patient's neurological status.