Carotid endarterectomy and local anaesthesia: reducing the disasters.
OBJECTIVE
The study was designed to assess one surgeon's operative mortality and morbidity for carotid endarterectomy using local anaesthetic (LA) compared to general anaesthetic (GA) techniques.


METHODS
Data were collected prospectively from 200 patients undergoing LA carotid surgery compared with 243 patients undergoing carotid surgery using GA technique. Indication for surgical, pathology, postoperative morbidity and mortality was assessed.


RESULTS
No major strokes or deaths occurred in the LA group (0/200). Significantly more major strokes and/or deaths occurred in the GA group (11/243, 4.5%; P=0.016). Significant less shunt usage was associated with LA (LA 18/200, 9% versus 94/243, 39%; P=0.001). The absence of a shunt was associated with more major events in the GA group (5/143, P=0.001. Age greater than 74 yr was associated with greater major events (4/31, P=0.002). No significant difference in the frequency of cardiovascular complications was observed (LA, 15/200 (7.5%) vs GA, 19/243(7.8%); P=0.924).


CONCLUSIONS
Local anaesthesia enables the surgeon to assess the level of cerebral perfusion with an awake patient, gives greater assurances of cerebral protection during arterial clamping and a provides for a more relaxed and cautious endarterectomy and repair. This study demonstrates reduction in mortality and major stroke events in patients operated on with these conditions.
Love
A
A
Vascular Department, Greenslopes Private Hospital, Brisbane, Australia.
Hollyoak
M A
MA
D000368:Aged; D000768:Anesthesia, General; D000772:Anesthesia, Local; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D002572:Cervical Plexus; D016894:Endarterectomy, Carotid; D006801:Humans; D009407:Nerve Block; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*