THE ADVANTAGES AND INFLUENCE OF REGIONAL ANAESTHESIA IN CAROTID SURGERY

Background: Carotid endarterectomy (CEA) is a low risk operation that reduces the risk of stroke in patients who harbor both symptomatic and asymptomatic carotid stenoses. Unfortunately the surgical therapy also has some mortality and morbidity rates. The most important factor to minimalize this rate is reliable monitoring of cerebral perfusion during the surgery. In this study we aimed to investigate the potential advantages and disadvantages of regional anesthesia in patients undergoing CEA.

Methods: Between june 2004 – june 2005, 25 CEA operations in 24 patients, under regional anaesthesia were performed. Sixty percent of patients were preoperative symptomatic, 92 % of patients classificated as ASA IV. In 20 patients, only CEA and in 5 patients CEA and coronary artery bypass grafting (CABG) together were performed.

Result: There is only one patient who had experienced respiratory arrest and entubated and then followed by CEA+CABG. We have used patchplasty technique in 18 patients and primary repair in 7 patients. Carotid shunt was used in 2 patients. The mean carotid clamp time was 31.3±3.6 min. (27- 45) and operation time was 116.9±15.4 min. (90- 150). There were no strokes among the patients.

Conclusion: Regional anaesthesia in carotid surgery is attractive and gaining in popularity because of easy and reliable monitorıng of cerebral perfusion therefore minimalize the use of selective shunting, lower overall costs and possibly a lower incidence of morbidity and mortality. The experience of the surgical and anaesthetic teams and patient co-operation is probably the most important factor in deciding which anaesthetic technique to use for Carotid Surgery. (Turkish J Vasc Sur 2007;16(1):1-4)