title: The impact of anesthetic modality on the outcome of carotid endarterectomy.
abstract: BACKGROUND
  Carotid endarterectomy (CEA) reduces the risk of stroke in patients with high-grade carotid artery stenosis. This study evaluates the clinical outcome of CEA performed under local anesthesia (LA) versus general anesthesia (GA).
  
  
  METHODS
  Clinical variables and treatment outcomes were analyzed in 548 CEAs performed under either LA or GA during a 30-month period. Factors associated with morbidity were also analyzed.
  
  
  RESULTS
  A total of 263 CEAs under LA and 285 CEA under GA were analyzed. The LA group was associated with a lower incidence of shunt placement, operative time, and perioperative hemodynamic instability compared to the GA group. No differences in neurologic complications or mortality were found between the 2 groups. Hyperlipidemia was a risk factor for postoperative morbidity in both the LA and GA groups, while age greater than 75 years was associated with increased overall morbidity in the GA group but not the LA group.
  
  
  CONCLUSIONS
  This study demonstrates that increased age is associated with increased morbidity in CEA under GA, while hyperlipidemia is associated with increased morbidity in CEA regardless of the anesthetic choice.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine and the Methodist Hospital, Houston VAMC-2002 Holcomb Blvd. (112), Houston, TX 77030, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Watts
authors.forename: Peter H
authors.initials: PH
authors.lastname: Lin
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Bush
authors.forename: Samir
authors.initials: S
authors.lastname: Awad
authors.forename: Sally A
authors.initials: SA
authors.lastname: McCoy
authors.forename: Deborah
authors.initials: D
authors.lastname: Felkai
authors.forename: Wei
authors.initials: W
authors.lastname: Zhou
authors.forename: Liz
authors.initials: L
authors.lastname: Nguyen
authors.forename: Marlon A
authors.initials: MA
authors.lastname: Guerrero
authors.forename: Salwa A
authors.initials: SA
authors.lastname: Shenaq
authors.forename: Alan B
authors.initials: AB
authors.lastname: Lumsden
mesh_terms: D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome