[Carotid endarterectomy under cervical epidural anesthesia].
General anesthesia for carotid endarterectomy (CEA) imposes the need for various monitorings of cerebral function during occlusion of the carotid artery. However, there is no ideal method for detecting all the signs of cerebrovascular insufficiency under general anesthesia. We suggest that the patient's neurological state is the best monitor of cerebral function. Therefore, our patients underwent cervical epidural anesthesia (EDA) enabling them to remain conscious while experiencing analgesia of the operated areas throughout the course of the operation. Five patients with cervical internal carotid artery stenosis were operated on under EDA with lidocaine. In all patients, EDA was effective in maintaining an analgesic state in the areas being operated on. It was able to do this either alone, or in combination with a light sedation. Under EDA, although there was no complete suppression of the patient's respiration, blood pressure was elevated beyond 200mmHg in three patients and depressed to 70mmHg in one patient transiently during the operation. But control of abnormal blood pressure was achieved easily by injections of calcium antagonist or ephedrine. When consciousness of two patients deteriorated during the clamping of the internal carotid artery, it completely recovered to its preoperative level after the insertion of an internal shunt. The patient's level of neurological condition became a good guide for predicting the need for an internal shunt during the periods of occlusion of the internal carotid artery. In conclusion, we suggest that EDA which is a safe and useful anesthesia should be employed in many patients who undergo CEA.
Asano
Y
Y
Department of Neurosurgery and Anaesthesia, Kariya General Hospital, Aichi, Japan.
Hasuo
M
M
Shimosawa
S
S
Nakamura
F
F
Sunohara
K
K
D000368:Aged; D000767:Anesthesia, Epidural / Q000379:methods; D016893:Carotid Stenosis / Q000601:surgery; D002544:Cerebral Infarction / Q000601:surgery; D003243:Consciousness; D016894:Endarterectomy, Carotid; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative