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A unique anesthesia approach for carotid endarterectomy: Combination of general and regional anesthesia
Sukhen Samanta1, Sujay Samanta2, Nidhi Panda3
1Department of Anesthesia and Critical Care (Trauma Centre), JPNA Trauma Centre, AIIMS, New Delhi, India.
Insights
Carotid endarterectomy (CEA) using combined general and local anesthesia improved patient hemodynamics and outcomes. This anesthesia approach offers a promising alternative for managing patients undergoing CEA.
Area of Science:
- Neurosurgery
- Anesthesiology
- Vascular Surgery
Background:
- Carotid endarterectomy (CEA) is crucial for preventing cerebrovascular stroke in patients with significant carotid stenosis.
- Peri-operative management for CEA is complex due to comorbidities and risks of stroke and myocardial infarction.
- General anesthesia (GA) is common, but local regional anesthesia (LRA) techniques offer alternatives.
Observation:
- This study explored a combined GA and LRA approach for CEA.
- The LRA component involved superficial and intermediate cervical plexus block with ropivacaine and dexmedetomidine infiltration.
- Hemodynamic stability was monitored during intraoperative and postoperative periods.
Findings:
- The combined GA and LRA technique resulted in improved intraoperative and postoperative hemodynamics.
- Patients exhibited better overall postoperative outcomes compared to traditional methods.
- The intermediate cervical plexus block, combined with GA, proved effective and technically manageable.
Implications:
- Combined GA and LRA represents a potentially superior anesthetic strategy for carotid endarterectomy.
- This technique may enhance patient recovery and reduce peri-operative complications.
- Further large-scale randomized trials are recommended to validate these findings.
Abstract:
Carotid endarterectomy (CEA), a preventable surgery, reduces the future risks of cerebrovascular stroWke in patients with marked carotid stenosis. Peri-operative management of such patients is challenging due to associated major co-morbidities and high incidence of peri-operative stroke and myocardial infarction. Both general anesthesia (GA) and local regional anesthesia (LRA) can be used with their pros and cons. Most developing countries as well as some developed countries usually perform CEA under GA because of technical easiness. LRA usually comprises superficial, intermediate, deep cervical plexus block or a combination of these techniques. Deep block, particularly, is technically difficult and more complicated, whereas intermediate plexus block is technically easy and equally effective. We did CEA under a combination of GA and LRA using ropivacaine 0.375% with 1 mcg/kg dexmedetomidine (DEX) infiltration. In LRA, we gave combined superficial and intermediate cervical plexus block with infiltration at the incision site and along the lower border of mandible. We observed better hemodynamics in intraoperative as well as postoperative periods and an improved postoperative outcome of the patient. So, we concluded that combination of GA and LRA is a good anesthetic technique for CEA. Larger randomized prospective trials are needed to support our conclusion.