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Related Experiment Videos

Carotid surgery under local anesthesia in the elderly.

A Mashiah1, D Soroker, S Pasik

  • 1Vascular Surgery Unit, Kaplan Hospital, Rehovot, Israel.

Journal of the American Geriatrics Society
|June 1, 1988
PubMed
Summary

Carotid endarterectomy in elderly patients under local anesthesia is safe, with no 30-day deaths. Neurological monitoring accurately predicts the need for intraoperative shunts, making the procedure ideal for high-risk individuals.

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Area of Science:

  • Vascular Surgery
  • Anesthesiology
  • Geriatric Medicine

Background:

  • Carotid endarterectomy is a crucial procedure for stroke prevention.
  • Elderly patients often present with comorbidities, increasing surgical risks.
  • Local anesthesia with neuroleptic analgesia offers a potential alternative to general anesthesia.

Purpose of the Study:

  • To evaluate the safety and efficacy of carotid endarterectomy under local anesthesia and neuroleptic analgesia in elderly patients.
  • To assess the utility of neurological monitoring for determining the need for intraoperative shunts.
  • To identify the suitability of this anesthetic approach for elderly patients with specific comorbidities.

Main Methods:

  • Carotid endarterectomy was performed on 39 elderly patients.

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  • Procedures were conducted under local anesthesia and neuroleptic analgesia.
  • Intraoperative neurological monitoring was employed to assess for ischemic changes.

    • Main Results:

    • No deaths occurred within 30 days post-procedure.
    • Two patients (5%) required intraoperative shunts due to neurological deficits during test cross-clamping.
    • Transient vocal cord paresis occurred in two patients, and 18% experienced immediate postoperative hypertension.

    Conclusions:

    • Carotid surgery under local anesthesia and neuroleptic analgesia is a safe and effective option for elderly patients.
    • Simple neurological monitoring reliably indicates the need for intraoperative shunts in awake patients.
    • This anesthetic technique is particularly recommended for elderly patients with hypertension, diabetes mellitus, or ischemic heart disease.