Carotid endarterectomy under regional anaesthesia at Dunedin Hospital, New Zealand: 1994-2003.
OBJECTIVE
Carotid endarterectomy (CEA) under local or regional anaesthesia is being considered more often by vascular surgeons to improve cerebral monitoring and to reduce general anaesthetic complications. The purpose of this study was to audit the results of CEA under regional anaesthesia in a New Zealand hospital (Dunedin Hospital, Otago Province).


METHODS
All carotid endarterectomies performed consecutively by one surgeon under regional anaesthesia over a 9-year period from November 1994 were reviewed. The cases and early complications were identified from a computerised audit database with prospective data input and all case notes were retrospectively reviewed for demographic data, comorbidity, the primary endpoints of stroke or death, and other complications of CEA. General practitioners and neurologists were contacted where follow-up information was incomplete.


RESULTS
During the review period, 135 CEAs were performed in 132 patients. The need for shunting was accurately predicted in all but one patient. The stroke rate was 0.7% and 30-day mortality rate 0.7% thus giving a combined risk of stroke or mortality of 1.4%. No patient had a myocardial infarction in the perioperative period despite 46% of the patients having ischaemic heart disease. There were 10 late deaths over the 9-year period of review.


CONCLUSIONS
CEA under regional anaesthesia is a safe operation even in patients with coronary disease and in a low volume setting. Moreover, it allows monitoring of cerebral ischaemia and the safe use of selective shunting. The results are comparable to other recently published series and provide a baseline for comparison with newer treatment modalities.
Department of Surgery, Dunedin Hospital, Dunedin, New Zealand. ian.thomson@stonebow.otago.ac.nz
Ian
I
Thomson
Medhat
M
Fanous
D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000706:statistics & numerical data*; D000768:Anesthesia, General / Q000706:statistics & numerical data; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D009520:New Zealand; D012307:Risk Factors; D016019:Survival Analysis