Cardiovascular Complications of Carotid Endarterectomy under Regional Anaesthesia Technique:a Comparison of Cervical Plexus Block and Cervical Epidural Anaesthesia

Overview

Objective:
The aim of this retrospective study was to evaluate a haemodynamic profile of the patients during carotidendarterectomy under regional anaesthesia technique and to compare the perioperative cardiovascular stability andcomplication rate of cervical plexus block (CPB) and cervical epidural anaesthesia (CEA).Design: Retrospective clinical study.Setting: Department of Cardiovascular Anaesthesia and Intensive Care, Na Homolce Hospital, Prague, Czech Republic,Department of Transplant Surgery, IKEM, Prague, Czech Republic.Material and Methods: A total of 529 carotid artery endarterectomies performed under regional anaesthesia in 1998–2003period were included into this retrospective study. A total of 313 procedures were performed using cervical plexus block,while cervical epidural anaesthesia was used in 216 operations. The evaluated parameters included the systolic, diastolicand mean arterial pressures, heart rate before, during and after the procedure. The circulatory complications, includingchest pain, ST segment depression and acute myocardial infarction in the perioperative period were also evaluated. Theobtained data were analyzed statistically using chi-square test.Results: Hypertension requiring a pharmacological intervention was noted in 181 patients in a CPB group (57.8%) and in25 patients in a CEA group (11.6%) respectively; P < 0.001. Hypotension and/or bradycardia were recorded in 30 patientsin a CPB group (9.6%) and in 41 patients in a CEA group (18.9%). Life threatening dysrhytmias were noted in 16 cases (3.0%)(14 cases in a CPB group, 2 cases in a CEA group) (P < 0.05). An acute myocardial infarction complicated the perioperativecourse in 6 CPB/1 CEA (1.9% vs. 0.5%). Total intraoperative mortality in the cohort was 6 patients (1.1%, 5 CPB/1 CEA). 4deaths were related to intraoperative stroke, 1 death (the patient in a CPB group) because of the myocardial infarction withsubsequent heart failure, 1 patient died on a respiratory failure following to bronchopneumonia.Conclusion: Both techniques of regional anaesthesia are reliable for carotid artery surgery. A cervical plexus block isassociated with higher rates of cardiovascular complications related mainly to hypertension and the risk of perioperativemyocardial ischemia.We recommend to use cervical epidural anaesthesia in patients with a serious cardiac history, mainlybecause of its ability to block the stress response and its coronary dilating effect.

Key words:
carotid endarterectomy – cervical plexus block – cevical epidural anaesthesia – haemodynamic status –perioperative myocardial ischaemia