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Hemodynamic benefits of regional anesthesia for carotid endarterectomy
Yaron Sternbach1, Karl A Illig, Renyu Zhang
1Center for Vascular Disease, Strong Memorial Hospital, and the Division of Vascular Surgery, University of Rochester School of Medicine, NY, USA. yaron_sternbach@urmc.rochester.edu
Objective:
The objective of this study was to define differences in perioperative hemodynamics and associated outcomes in patients who undergo carotid endarterectomy (CEA) with regional and general anesthesia.
Methods:
All the patients who underwent CEA during a 25-month period were reviewed, with a comparison of those who underwent operation with cervical block anesthesia (CB) with those who underwent operation with general anesthetic (GA). Baseline intraoperative and postoperative blood pressure and heart rate were recorded, and deviation from initial values was calculated. The administration of vasoactive medications was assessed. Operative time, intensive care unit admission, postoperative length of stay, and cardiac/neurologic morbidity were recorded.
Results:
From October 16, 1998, to December 1, 2000, 550 nonemergent CEAs were performed in 527 patients (226 with CB and 324 with GA). The patients in both groups were similar in age, presentation, and associated comorbidities. Although baseline blood pressure and heart rates were similar in both groups, those patients who underwent operation with GA had significantly greater intraoperative and postoperative hemodynamic variability and received more vasoactive medications during surgery (87% versus 51%; P <.001) and in the recovery room (36% versus 21%; P =.0009). Major postoperative blood pressure derangements were more common in the GA group (18% versus 10%; P <.05). Patients who underwent operation with GA more frequently needed intensive care unit admission (16% versus 7%; P =.01) and had more frequent delays in discharge (20% versus 11%; P =.008; postoperative length of stay, 2.1 versus 1.6 days; P =.01). Although no difference was seen in neurologic morbidity rates between groups (combined major stroke/death rate, 1.8%), the major cardiac morbidity rate was noted to be lower in the CB group (1% versus 4%; P =.05). The total in-room time was shorter in the CB group (108 versus 122 minutes; P <.001).
Conclusion:
CEA performed with CB is associated with significantly less perioperative hemodynamic instability than with GA. This results in fewer major adverse cardiac events. Ultimately, decreased critical care resource use is realized as is a shortened length of stay.