Anesthesia for carotid endarterectomy: a survey

Indications for carotid endarterectomy (CEA) have been expanded recently, and a consensus statement has been made regarding these changes. However, the debate regarding the "ideal" anesthetic for CEA remains on-going. This study was designed to evaluate the actual anesthetic techniques used by anesthesiologists for CEA. A total of 426 1-page questionnaires were mailed to all current (1995) members of the Society of Neurosurgical Anesthesia and Critical Care (SNACC). Of these, 216 (50.7%) were completed and returned. The majority of these respondents (84.7%) administered general anesthesia (GA) for CEA. Regional anesthesia (RA) was the anesthetic method of choice for 16.7%, whereas 2.8% each chose either local anesthesia (LOC) or a combined regional/general (RA/GA) technique. Despite the controversial role of nitrous oxide in neuroanesthesia, 74.6% of those returning the survey use nitrous oxide during CEA. Intraoperative neuromonitoring use was reported by 90% of the respondents, with the electroencephalography (EEG) the favored modality (67.5%). Specific intraoperative neuroprotective measures were provided by only 22.2% of all respondents, with barbiturates as the favorite method (50.0%). The technique of intraoperative hypertension is practiced by a majority of those surveyed (61.1%), with the most common target blood pressures being either preoperative baseline or preoperative baseline plus 20%. Although there is some trend towards nonintensive care setting for postoperative care, the intensive care remains the location of choice for overnight care of CEA patients (71.8%). The results of this study show that despite arguments for RA over GA, the majority of anesthesiologists surveyed choose GA for CEA.