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Published on: December 23, 2014
Regional anesthesia for carotid surgery
1Department of Anesthesia, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada. joanne.guay@umontreal.ca
Current Opinion in Anaesthesiology
|September 12, 2008
Summary
Regional anesthesia, specifically a superficial cervical plexus block, is recommended for carotid endarterectomy. This technique is effective and safer than general anesthesia, reducing major complications like stroke and death.
Area of Science:
- Anesthesiology
- Neurosurgery
- Cardiovascular Surgery
Background:
- Retrospective studies suggest regional anesthesia reduces major complications (stroke, death, myocardial infarction) during carotid endarterectomy compared to general anesthesia.
- Carotid endarterectomy is a surgical procedure to remove plaque from carotid arteries, reducing stroke risk.
Purpose of the Study:
- To evaluate the efficacy and safety of regional anesthesia techniques for carotid endarterectomy.
- To identify the optimal regional anesthetic technique and agents for this procedure.
Main Methods:
- Review of evidence on regional anesthesia for carotid endarterectomy.
- Focus on superficial cervical plexus block as the preferred technique.
Main Results:
- Superficial cervical plexus block is as effective as combined blocks but with significantly lower risks of life-threatening complications.
- Suitable anesthetic agents include lidocaine, mepivacaine, bupivacaine, and ropivacaine; bupivacaine offers prolonged postoperative pain relief.
- Adding epinephrine (1:300,000) to local anesthetics reduces peak blood concentrations without adverse hemodynamic effects.
Conclusions:
- Anesthesiologists should master the superficial cervical plexus block technique.
- This technique is easy to learn, effective, and associated with a low risk of serious complications during carotid endarterectomy.
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