[Carotid endarterectomy under locoregional anesthesia].
The purpose of carotid surgery is to prevent the incidence of stroke in patients with cerebrovascular disease. It's important, therefore, to find the most useful methods of cerebral protection and flow monitorization during carotid endarterectomy. It is well known that patient's clamping tolerance changes according to his anatomical and physiopathological conditions (contralateral carotid patency, stenosis, occlusion), and compensative circles efficiency (Willis). General anaesthesia reduces cerebral metabolic requests and allows a better pressure control, but requires difficult, expensive and complex monitoring techniques. On the contrary loco-regional anaesthesia alone can't assure cerebral protection, but allows to test in real-time patient's reaction at clamping. If an ischaemia occurs, carotid shunting allows to perform endarterectomy, but this method might produce any complication: distal plaque dissection, embolizations. Authors show their 10 years (1986-1996) experience of 624 carotid endarterectomies performed on 580 patients evaluated by: -symptomatic or asymptomatic lesions -mono-bilateral stenosis -general or loco-regional anaesthesia -clamping tolerance -carotid shunting -intra-postoperative complications (temporary or persistent). According to results, authors propose loco-regional anaesthesia in carotid endarterectomy as a simply available and at low costs method to monitorize cerebral functions. In addition it has low rate complications, few contra-indications and may be selected like first-choice anaesthesiological method.
Bonalumi
F
F
Istituto di Chirurgia Vascolare ed Angiologia dell'Università di Milano.
Vitiello
R
R
Miglierina
L
L
Campanati
B
B
Bianchi
F
F
Marrocu
R
R
D000765:Anesthesia, Conduction / Q000379:methods*; D000772:Anesthesia, Local; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D002572:Cervical Plexus; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods; D018579:Patient Selection
Endoarteriectomia carotidea in anestesia locoregionale.