Regional or general anesthesia for carotid endarterectomy? Evidence from published prospective and retrospective studies.
OBJECTIVE
The aim of this study was to compare outcomes of patients undergoing carotid endarterectomy under regional or general anesthesia for any new neurologic impairment, stroke, stroke and/or death, death, and myocardial infarction.


METHODS
Meta-analysis.


METHODS
A search of the National Library of Medicine of the United States PUBMED from 1966 up to June 11, 2005, with the following key words: "carotid surgery or endarterectomy and regional anesthesia."


RESULTS
Forty-eight studies (14 prospective and 34 retrospective) were analyzed. The optimal information size was achieved only when all studies were analyzed together (prospective and retrospective). Regional anesthesia reduced the rate of any new neurologic impairment (odds ratio = 0.60; 95% confidence interval, 0.48-0.75; p < 0.00001), stroke (0.54 [0.43-0.68], p < 0.00001), stroke and/or death (0.62 [0.49-0.78], p < 0.0001), death (0.65 [0.48-0.87], p = 0.004), and myocardial infarction (0.50 [0.36-0.70], p < 0.0001).


CONCLUSIONS
The number of patients included in randomized controlled trials or even in prospective studies is too low to allow any conclusions on the differences in outcome between the 2 anesthetic techniques. Better outcomes are suggested when results from retrospective studies are added.
Guay
Joanne
J
Department of Anesthesia, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada. joanne.guay@umontreal.ca
D000765:Anesthesia, Conduction / Q000009:adverse effects* / Q000401:mortality; D000768:Anesthesia, General / Q000009:adverse effects* / Q000401:mortality; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D009203:Myocardial Infarction / Q000453:epidemiology; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000453:epidemiology