[Cervical epidural anesthesia in carotid artery surgery]

A series of 394 patients who underwent surgery of the carotid artery under cervical extradural anaesthesia is presented. With this technique the patient remains conscious throughout the operation, which facilitates neurological monitoring. Due to failure or complication, extradural anaesthesia was abandoned and replaced by general anaesthesia in 1.5 per cent of the cases. The mortality rate in this series was 2.3 per cent; in 2 out of 3 cases death was of neurological origin; 21 per cent of the patients had peroperative neurological accidents which, in 9 out of 10 cases, were due to a low cerebral blood flow rate during clamping. Thirty-five intra-arterial shunts (8.9 per cent) were installed, and none of these accidents was permanent. Twenty-five patients (6.3 per cent) had postoperative deficit which did not regress in 12 cases (3 per cent). The risk of peroperative neurological accident was significantly increased in patients with bilateral lesions of the vertebral arteries (x 3.5) or with occlusion of the contralateral carotid artery (x 4.5). Surgery of the carotid artery in conscious patients reveals a high incidence of ischaemic neurological events the reversibility of which is ensured by appropriate therapeutic procedures (arterial shunt, increase of brain perfusion pressure). Patients at risk of neurological accidents may benefit from cervical extradural anaesthesia.