Regional anaesthesia and propofol sedation for carotid endarterectomy.
BACKGROUND
Many surgeons now perform carotid endarterectomy under regional anaesthesia. The aim of the present study was to review a sedation technique using a computer-controlled infusion of propofol.


METHODS
A consecutive series of 84 carotid endarterectomies done by a single surgeon and commenced under regional anaesthesia with sedation was studied. There were 54 men and 27 women (three bilateral procedures), with a median age of 71 years (range 48-87 years). All patients had carotid stenosis > 70% 80 procedures were done for symptomatic disease and three asymptomatic patients were treated before cardiac surgery (one bilateral).


RESULTS
Seventy-seven procedures were completed under regional anaesthesia and sedation alone; seven required conversion to general anaesthetic, usually for intolerance of the operation. An intraoperative shunt was required on only four occasions (5%). Postoperatively eight patients required critical care monitoring, usually for blood pressure control. The remainder were nursed on the vascular ward, and 68% were discharged home on the day after surgery. No patient died, but there were two neurological complications. One patient had a cerebellar stroke 10 days after surgery, but recovered fully after 4 months. A second developed cerebral oedema due to severe intraoperative hypertension and required intensive care for 15 days. He too recovered fully. Five patients had a further episode of transient cerebral ischaemia within 1 month of operation, but in all cases duplex imaging showed a widely patent carotid and there were no sequelae.


CONCLUSIONS
Target controlled propofol infusion is an effective method of sedation in patients undergoing carotid endarterectomy.
Gloucestershire Vascular Group, Gloucestershire Royal Hospital, Gloucester, United Kingdom.
Christopher
C
Barringer
John M
JM
Williams
Alastair
A
McCrirrick
Jonothan J
JJ
Earnshaw
D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D016893:Carotid Stenosis / Q000601:surgery; D016292:Procedural Sedation; D004360:Drug Therapy, Computer-Assisted; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D015742:Propofol
D006993:Hypnotics and Sedatives; D015742:Propofol