Carotid endarterectomy. A survey of UK anaesthetic practice

We conducted a postal questionnaire survey of the members of the Vascular Anasthesia Society of Great Britain and Ireland, asking questions about the provision of anasthesia for carotid endartectomy. Of 215 respondents, 187 were currently providing anasthesia for carotid endarterectomy. The majority of respondents (69%) always use general anasthesia for this operation but 99/215 (46%) had some experience of regional anasthesia for carotid endartectomy. Amongst those currently using regional anasthesia, combined deep and superficial cervical plexus block was the technique used by 71%. Other regional techniques used included local infiltration and superficial block alone. During regional anasthesia, most (66%) anasthetists used cerebral monitoring techniques such as stump pressure or transcranial Doppler as well as keeping the patient awake. However, in a significant proportion of cases (37%) under general anasthesia no cerebral monitoring was used. Reported surgical shunt insertion rates were lower in awake (mean 42%) patients than those receiving general anasthesia (61%). Respondents using regional anasthesia were more likely to feel that their technique was appropriate than those using general anasthesia.