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Wake-up test decrease shunts insertion during carotid endarterectomy under general anesthesia.

Luigi Vetrugno1, Elena Di Luca, Daniela Drigo

  • 1Cardiothoracic and Vascular Anesthesia, University-Hospital of Udine, Udine, Italy. vetrugnoluigi@katamail.com

Vascular and Endovascular Surgery
|February 13, 2010
PubMed
Summary

The wake-up test (WUT) is a reliable method for assessing neurological status during carotid endarterectomy (CEA) and determining the need for shunting. Fewer patients required shunting using WUT compared to the traditional stump pressure (SP) method.

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Area of Science:

  • Anesthesiology
  • Neurosurgery
  • Vascular Surgery

Background:

  • The choice between locoregional anesthesia and general anesthesia (GE) for carotid endarterectomy (CEA) remains a subject of clinical debate.
  • Assessing neurological status during CEA is crucial for determining the need for shunting to prevent cerebral ischemia.

Purpose of the Study:

  • To compare the efficacy of the wake-up test (WUT) with stump pressure (SP) in identifying patients requiring shunting during CEA under GE.
  • To evaluate the percentage of patients needing shunts based on WUT versus an SP cutoff of ≤40 mm Hg.

Main Methods:

  • A retrospective, observational study was conducted at a university hospital.
  • Three hundred fifty-one patients (ASA physical class II-III) undergoing CEA under GE were included.
  • The WUT involved assessing patient's neurological response to verbal stimuli during reduced anesthesia, while SP was measured at a cutoff of ≤40 mm Hg.

Main Results:

  • Of 343 evaluable patients, 20 (5.8%) required shunting based on a positive WUT.
  • In comparison, 45 patients (12.8%) met the criteria for shunting based on SP ≤40 mm Hg.

Conclusions:

  • The wake-up test (WUT) provides a direct and effective method for assessing neurological status during CEA to guide shunting decisions.
  • WUT identified fewer patients requiring shunting compared to the traditional SP criteria, suggesting improved patient selection for shunts.