Local versus general anaesthesia in carotid surgery. A prospective, randomised study

Area of Science:

• Vascular Surgery
• Anesthesiology
• Neurology

Background:

• Carotid endarterectomy is a common procedure to prevent stroke.
• Anesthesia choice (local vs. general) impacts surgical management and patient outcomes.
• Intra-operative shunting is used to maintain cerebral perfusion during carotid clamping.

Purpose of the Study:

• To compare local anesthesia (LA) and general anesthesia (GA) in carotid surgery.
• To evaluate complications and the necessity of intra-operative shunting.
• To assess the impact of anesthesia on perioperative neurological deficits and blood pressure.

Main Methods:

• A randomized prospective study comparing LA and GA in 111 patients undergoing carotid endarterectomy.
• Patients were randomized to either LA (n=56) or GA (n=55).
• Data collected included perioperative complications, neurological deficits, shunt usage, and blood pressure.

Main Results:

• Seven perioperative neurological deficits occurred (5.6%) with similar rates in both groups.
• Significantly fewer patients required intra-operative shunts in the LA group (5) compared to the GA group (25) (P < 0.001).
• The LA group experienced significantly higher systolic blood pressures (210 mmHg vs. 173 mmHg, P < 0.001).

Conclusions:

• Local anesthesia is a viable alternative to general anesthesia for carotid endarterectomy, with comparable complication rates.
• LA significantly reduces the need for intra-operative shunting and allows for direct neurological monitoring.
• Higher blood pressures observed in the LA group require careful management.