title: Effectiveness and safety of carotid endarterectomy under remifentanil.
abstract: OBJECTIVE
  The aim of this study was to evaluate the effectiveness and safety of carotid endarterectomy (CEA) with conscious sedation under remifentanil (Remifentanil anesthesia - RA) vs conventional loco-regional anesthesia (Conventional-LRA) in the current practice of a vascular surgery unit.
  
  
  METHODS
  We introduced the ''Remifentanil-RA'' in our practice according to a two-step protocol. In the first step we performed a pilot prospective study to assess the procedure's safety and reproducibility in our setting on 60 consecutive patients with symptomatic and/or high-grade (>70%) internal carotid artery stenosis and alternately assigning them either to ''Remifentanil-RA'' or ''Conventional-LRA'' CEA. In the second step we analysed our routine operative records as to effectiveness and safety on 533 patients who consecutively underwent ''Remifentanil-RA'' CEA. We compared them with 533 age- and sex-matched historical controls who underwent ''Conventional-LRA'' CEA.
  
  
  RESULTS
  The patients' mean age was 71.2+/-6.8 vs 71.8+/-6.1 (''Remifentanil-RA'' vs ''Conventional-LRA''). About 73% of them were male and 56% had a symptomatic carotid stenosis. Neither the pilot study nor second step comparison showed differences in outcome measures. We found only higher peri-operative nausea/ vomit (3.6% vs 0.4% ''Remifentanil-RA'' vs ''Conventional-LRA'', P<0.0002) and fewer re-operations for post-operative hematomas (3% vs 5.4% respectively, P=0.048).
  
  
  CONCLUSIONS
  We found that ''Remifentanil-RA'' CEA was safe, effective and satisfactory. Nevertheless, with the potential problems of intubation and those already found with side effects, a randomized control trial (RCT) is needed in order to prove that this method is superior to ''Conventional-LRA'' CEA.
authors.affiliation: Department of Vascular Surgery, S. Agostino Hospital, Modena, Italy. g.coppi@ausl.mo.it
authors.forename: G
authors.initials: G
authors.lastname: Coppi
authors.forename: R
authors.initials: R
authors.lastname: Moratto
authors.forename: G
authors.initials: G
authors.lastname: Ragazzi
authors.forename: E
authors.initials: E
authors.lastname: Nicolosi
authors.forename: R
authors.initials: R
authors.lastname: Silingardi
authors.forename: G
authors.initials: G
authors.lastname: Benassi Franciosi
authors.forename: M
authors.initials: M
authors.lastname: Rambaldi
authors.forename: A
authors.initials: A
authors.lastname: Navi
authors.forename: A V
authors.initials: AV
authors.lastname: Ciardullo
mesh_terms: D000368:Aged; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000601:surgery*; D016292:Procedural Sedation / Q000379:methods*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D010880:Piperidines / Q000627:therapeutic use*; D011446:Prospective Studies; D000077208:Remifentanil; D016896:Treatment Outcome
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil