Carotid endarterectomy: comparing anesthesia in awakened and intubated patients with general anesthesia

The purpose of this study was to determine utility and efficacy of anesthesia with remifentanil in awakened and intubated patients in comparison with general anesthesia and routine shunting.

Hundred patients were randomized for general anesthesia (group A) or anesthesia with remifentanil (group B). The two groups were compared in terms of postoperative outcome, neurological complications, arterial pressure during intervention and in during the following 36 hours. Group B patients answered a proposed questionnaire about intraoperative and postoperative degree of comfort, fear, pain and discomfort for the orotracheal tube.

The two groups differed significantly only for age (group B>A); 10% of patients was not considered fit for the anesthesia with remifentanil (initial experience only). The two groups did not differ in terms of central neurologic complications (0%), general complications or technical problems in terms of intra-operative arterial pressure problems (the anesthesia with remifentanil caused less hypertensive problems (P>0,19) and (not technique-dependent) peripheral neurologic deficits. All patients accepted the method and did not report fear or discomfort. Only 3 patients (6.6%) described light pain during the intervention. In 2 cases (4.4%) the surgeon complained about the restlessness of the patient; this did not cause a change in procedure.

General anesthesia with remifentanil produces an association between the advantage of locoregional anesthesia and those of general anesthesia, probably lowering the risk for the patients.