Carotid endarterectomy surgery and ICU admissions: a regional anesthesia perspective

Stroke is a major cause of mortality and morbidity in the United States. This study was performed to determine whether the authors' practice of monitoring the majority of patients in the postanesthesia care unit for 2 hours, selectively admitting the recovering carotid endarterectomy patients to the intensive care unit when feasible, and using regional anesthesia for the majority of cases, resulted in adverse outcomes or compromised the safety of the operation at a tertiary care academic medical center. The records of 337 patients (a total of 420 procedures) who underwent carotid endatertectomy surgery without concurrent heart surgery during a consecutive 18-month period ending in June, 1995 were reviewed. Regional anesthesia was the technique used in 97% of the procedures. Shunt placement was deemed necessary in 7% of the procedures. Postoperative strokes occurred in approximately 1% of patients. No shunted patients had a postoperative stroke. The rate of admission to intensive care units was 4%. Blood pressure control accounted for 73% of the patients admitted to intensive care units. Most patients required 2 hours of monitoring in the postanesthesia care unit before triage to the appropriate level of postoperative care. These results suggest that a monitoring period of 2 hours in the postanesthesia care unit allows for safe assessment of the postoperative carotid endarterectomy patient, and that routine intensive care unit admission after carotid endarterectomy surgery is not necessary.