Clinical outcomes after carotid endarterectomy: comparison of the use of regional and general anesthetics

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Object. The authors analyzed their series of carotid endarterectomies (CEAs), which were performed after administration of either a general or regional anesthetic, to determine whether the choice of anesthetic affected patients' clinical outcomes and length of hospital stay.

Methods. A series of 803 consecutive CEAs performed between July 1990 and February 1999 was reviewed. Cases were analyzed for patient demographics, comorbid medical states, and perioperative complications. Contingency-table statistical analysis was used to compare the incidence of comorbid medical states and perioperative complications between patients who underwent CEA in which either a regional or general anesthetic was used. Student's t-test was used to compare the length of hospital stay and mean patient age.

A regional anesthetic was used for 632 CEAs, and a general anesthetic was used for 171 operations. There were no statistically significant intergroup differences in demographics or comorbid medical states. The incidence of perioperative stroke and death did not differ significantly between the regional (2.7%) and the general anesthetic groups (2.3%). However, the incidence of nonneurological, nonfatal complications was significantly less in the regional anesthetic (1.6%) than in the general anesthetic group (14 .6%, p < 0.0001). Patients undergoing CEA in which a regional anesthetic was used had a significantly lower incidence of cardiopulmonary complications (myocardial infarction and postoperative intubation), cervical complications (neck hematomas and cranial nerve injuries), and urological complications (urinary retention) than patients who underwent surgery after receiving a general anesthetic.

Conclusions. Patients undergoing CEA in which a regional anesthetic was used had significantly fewer nonneurological, nonfatal complications, particularly cardiopulmonary complications, than similar patients surgically treated after induction of general anesthesia.

Article Information

Address reprint requests to: Robert E. Harbaugh, M.D., Department of Surgery (Neurosurgery), Dartmouth—Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire 03756. email: robert.e.harbaugh@hitchcock.org.

© AANS, except where prohibited by US copyright law.

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References

  • 1.

    Allen BTAnderson CBRubin BGet al: The influence of anesthetic technique on perioperative complications after carotid endarterectomy. J Vasc Surg 19:8348431994Allen BT Anderson CB Rubin BG et al: The influence of anesthetic technique on perioperative complications after carotid endarterectomy. J Vasc Surg 19:834–843 1994

  • 2.

    Back MRHarward TRSHuber TSet al: Improving the cost effectiveness of carotid endarterectomy. J Vasc Surg 26:4564621997Back MR Harward TRS Huber TS et al: Improving the cost effectiveness of carotid endarterectomy. J Vasc Surg 26:456–462 1997

  • 3.

    Corson JDChang BBShah DMet al: The influence of anesthetic choice on carotid endarterectomy outcome. Arch Surg 122:8078121987Corson JD Chang BB Shah DM et al: The influence of anesthetic choice on carotid endarterectomy outcome. Arch Surg 122:807–812 1987

  • 4.

    European Carotid Surgery Trialists' Collaborative Group: MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337:123512431991European Carotid Surgery Trialists' Collaborative Group: MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337:1235–1243 1991

  • 5.

    Executive Committee for the Asymptomatic Carotid Atherosclerosis Study: Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:142114281995Executive Committee for the Asymptomatic Carotid Atherosclerosis Study: Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:1421–1428 1995

  • 6.

    Forssell CTakolander RBergqvist Det al: Local versus general anesthesia in carotid surgery. A prospective randomised study. Eur J Vasc Surg 3:5035091989Forssell C Takolander R Bergqvist D et al: Local versus general anesthesia in carotid surgery. A prospective randomised study. Eur J Vasc Surg 3:503–509 1989

  • 7.

    Gabelman CGGann DSAshworth CJ Jret al: One hundred consecutive carotid artery reconstructions: local versus general anesthesia. Am J Surg 145:4774831983Gabelman CG Gann DS Ashworth CJ Jr et al: One hundred consecutive carotid artery reconstructions: local versus general anesthesia. Am J Surg 145:477–483 1983

  • 8.

    Harbaugh KSHarbaugh RE: Early discharge after carotid endarterectomy. Neurosurgery 37:2192251995Harbaugh KS Harbaugh RE: Early discharge after carotid endarterectomy. Neurosurgery 37:219–225 1995

  • 9.

    Harbaugh KSPikus HShumaker Get al: Increasing the value of carotid endarterectomy. J Neurovasc Dis 1:40471996Harbaugh KS Pikus H Shumaker G et al: Increasing the value of carotid endarterectomy. J Neurovasc Dis 1:40–47 1996

  • 10.

    Harbaugh RE: Carotid surgery using regional anesthesia. Tech Neurosurg 3:25331997Harbaugh RE: Carotid surgery using regional anesthesia. Tech Neurosurg 3:25–33 1997

  • 11.

    Hobson RW IIWeiss DGFields WSet al: Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med 328:2212271993Hobson RW II Weiss DG Fields WS et al: Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med 328:221–227 1993

  • 12.

    Kraiss LWKilberg LCritch Set al: Short-stay carotid endarterectomy is safe and cost-effective. Am J Surg 169:5125151995Kraiss LW Kilberg L Critch S et al: Short-stay carotid endarterectomy is safe and cost-effective. Am J Surg 169:512–515 1995

  • 13.

    Lanzino GGuterman LRHopkins LN: Carotid artery stenosis: the case for stenting. Clin Neurosurg 45:2492551997Lanzino G Guterman LR Hopkins LN: Carotid artery stenosis: the case for stenting. Clin Neurosurg 45:249–255 1997

  • 14.

    Loftus CM: Technical fundamentals, monitoring, and shunt use during carotid endarterectomy. Techn Neurosurg 3:16241997Loftus CM: Technical fundamentals monitoring and shunt use during carotid endarterectomy. Techn Neurosurg 3:16–24 1997

  • 15.

    Magnadottir HBLightdale NHarbaugh RE: Clinical outcomes for patients at high risk who underwent carotid endarterectomy with regional anesthesia. Neurosurgery 45:7867921999Magnadottir HB Lightdale N Harbaugh RE: Clinical outcomes for patients at high risk who underwent carotid endarterectomy with regional anesthesia. Neurosurgery 45:786–792 1999

  • 16.

    Mayberg MRWilson SEYatsu Fet al: Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA 266:328932941991Mayberg MR Wilson SE Yatsu F et al: Carotid endarterectomy and prevention of cerebral ischemia in symptomatic carotid stenosis. JAMA 266:3289–3294 1991

  • 17.

    Muskett AMcGreevy JMiller M: Detailed comparison of regional and general anesthesia for carotid endarterectomy. Am J Surg 152:6916941986Muskett A McGreevy J Miller M: Detailed comparison of regional and general anesthesia for carotid endarterectomy. Am J Surg 152:691–694 1986

  • 18.

    North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:4454531991North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453 1991

  • 19.

    Palmer MA: Comparison of regional and general anesthesia for carotid endarterectomy. Am J Surg 157:3293301989Palmer MA: Comparison of regional and general anesthesia for carotid endarterectomy. Am J Surg 157:329–330 1989

  • 20.

    Peitzman ABWebster MWLoubeau JMet al: Carotid endarterectomy under regional (conductive) anesthesia. Ann Surg 196:59641982Peitzman AB Webster MW Loubeau JM et al: Carotid endarterectomy under regional (conductive) anesthesia. Ann Surg 196:59–64 1982

  • 21.

    Sundt TMSandok BAWhisnant JP: Carotid endarterectomy. Complications and preoperative assessment of risk. Mayo Clin Proc 50:3013061975Sundt TM Sandok BA Whisnant JP: Carotid endarterectomy. Complications and preoperative assessment of risk. Mayo Clin Proc 50:301–306 1975

  • 22.

    Tangkanakul CCounsell CEWarlow CP: Local versus general anesthesia in carotid endarterectomy: a systematic review of the evidence. Eur J Vasc Endovasc Surg 13:4914991997Tangkanakul C Counsell CE Warlow CP: Local versus general anesthesia in carotid endarterectomy: a systematic review of the evidence. Eur J Vasc Endovasc Surg 13:491–499 1997

  • 23.

    Whisnant JPSandok BASundt TM Jr: Carotid endarterectomy for unilateral carotid system transient cerebral ischemia. Mayo Clin Proc 58:1711751983Whisnant JP Sandok BA Sundt TM Jr: Carotid endarterectomy for unilateral carotid system transient cerebral ischemia. Mayo Clin Proc 58:171–175 1983

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