Current view of anaesthesia for carotid surgery

Czech version

Authors: Horáček Michal ¹; Vymazal Tomáš ¹; Novotný Karel ²; Mošna František ¹; Filaun Martin ¹
Authors‘ workplace: Klinika anesteziologie, resuscitace a intenzivní medicíny, Fakultní nemocnice v Motole a 2. lékařská fakulta Univerzity Karlovy, Praha ¹; Klinika kardiovaskulární chirurgie, Fakultní nemocnice v Motole a 2. lékařská fakulta Univerzity Karlovy, Praha ²
Published in: Anest. intenziv. Med., 24, 2013, č. 1, s. 14-24
Category: Anesthesiology - Review Article

Overview

Carotid endarterectomy (CEA) is a standard treatment of serious symptomatic or asymptomatic stenoses of carotid arteries. It is a prophylactic operation performed more to reduce the risk of embolic stroke from atheromatous disease at the carotid bifurcation than to relieve the hemodynamic stenosis. The risk is reduced by 50% but the benefit can be realized only if the risks of operation and associated anaesthesia are lower than the achieved reduction of the risk of stroke. The most feared complications are death and peri-operative stroke. Myocardial infarction can occur as well. An important adverse event is also a cerebral hyper-perfusion syndrome. CEA can be carried under general, regional (cervical epidural blockade or superficial, intermediate or deep cervical block or their combinations) or local infiltration anaesthesia. Each anaesthetic technique must provide suffi-cient ventilation and oxygenation, cardiovascular stability and free cerebral venous drainage. It must also allow shunt insertion based on the sufficiency of cerebral perfusion. This can be accomplished by clinical neurological assessment (in awake patients) and/or by technical devices. Unfortunately, they do not have satisfactory sensitivity or specificity. Based on the studies performed, the safest techniques are general anae-sthesia with selective shunting determined by cerebral perfusion monitoring or superficial and/or intermediate cervical block. Regional anaesthesia seems more economical.

Keywords:
carotid endarterectomy – general anaesthesia – cervical epidural anaesthesia – superficial cervical block – intermedial cervical block – deep cervical block

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