[Carotid artery surgery with local anesthesia. Experiences with a series of 181 operations]

Between 1982 and 1984, 181 operations of the carotid artery were performed--180 of these in primary awake patients--36 in stage I (19.9%), 72 in stage II (39.8%), 72 in stage IV (39.8%) and only one in stage III (0.6%). 144 patients (79.6%) tolerated clamping of the carotid artery very well. In 37 patients (20.4%) clamping was not tolerated (two patients, in whom the control of cerebral function was not possible, were submitted to the latter group). In three of 181 patients clamping-intolerance started at the end of operation, more than 30 minutes after clamping. Clamping intolerance in these cases was found to be confined to pulmonary and cardiac factors, no shunt was used, but operation was brought to an end as quickly as possible. Complications were present in 15 patients (8.3%), three of them resulting in death (hospital mortality rate 1.7%), 2 of them in permanent loss of function (morbidity rate 1.1%). Only in 2 patients (asystolism with consecutive successful reanimation in one case, and thoracotomy due to enlargement of surgical procedure in the other case) a primary general anaesthesia would have facilitated surgery. Surgery of the carotid artery under local anaesthesia is considered to be a guarantee for a secure intraoperative surveillance followed by a low postoperative complication rate. In a few cases more difficult surgical procedures have to be accepted in account of that.