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Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Local versus general anaesthesia for carotid endarterectomy
C Tangkanakul1, C Counsell, C Warlow
1Neurosciences Trials Unit, Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh, UK, EH4 2XU. cpw@skull.dcn.ed.ac.uk
The Cochrane Database of Systematic Reviews
|May 5, 2000
Summary
Carotid endarterectomy under local anesthesia may reduce stroke and complications compared to general anesthesia. However, more high-quality randomized trials are needed to confirm these findings for stroke prevention.
Area of Science:
- Vascular Surgery
- Anesthesiology
- Neurology
Background:
- Carotid endarterectomy is a crucial procedure for reducing stroke risk in patients with severe carotid artery stenosis.
- Perioperative risks associated with this surgery can potentially be mitigated by using local anesthesia instead of general anesthesia.
Purpose of the Study:
- To evaluate the comparative effectiveness of carotid endarterectomy performed under local anesthesia versus general anesthesia.
Main Methods:
- A systematic review of randomized trials and non-randomized studies was conducted.
- Searches included major databases (Medline, Embase) and handsearched surgical journals.
- Data extraction and quality assessment were performed by independent reviewers.
Main Results:
- Limited data from three randomized trials (143 patients) precluded definitive conclusions due to questionable quality.
- Seventeen non-randomized studies (approx. 5970 patients) suggested local anesthesia was associated with reduced odds of stroke, stroke or death, myocardial infarction, and pulmonary complications.
- No significant difference in 30-day mortality was observed between local and general anesthesia in non-randomized studies.
Conclusions:
- Current evidence from randomized trials is insufficient to definitively compare local and general anesthesia for carotid endarterectomy.
- Non-randomized studies indicate potential benefits of local anesthesia, but are subject to significant bias.
- Further high-quality randomized controlled trials are warranted to establish the safety and efficacy of local anesthesia for this procedure.
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