Carotid endarterectomy under local anesthesia supplemented with neuroleptic analgesia

Surgical treatment of the carotid artery is being performed increasingly under local rather than general anesthesia. The advantage of local anesthesia is that neurologic function can be continuously assessed while the carotid arteries are cross-clamped, and unnecessary shunting can, thus, be avoided, with resulting sedation, analgesia, alpha blockade and blood pressure stability. The main objection to the use of local anesthesia is the anxiety of the patient. We overcame this difficulty in a series of 42 patients by supplementing the local anesthetic with neuroleptic analgesia. The possible disadvantages of neuroleptic administration are apnea and prolonged sedation. Only one of the patients we studied required an intraluminal shunt. One patient died of cardiac disease and one suffered an early postoperative stroke, which subsequently resolved. We believe that local anesthesia, supplemented by neuroleptic sedation and analgesia to overcome patient anxiety, should be more widely used for carotid endarterectomy.