Surgery of the carotid artery: local anaesthesia versus general anaesthesia.
OBJECTIVE
Carotid artery surgery is safely and commonly performed under general, regional or local anaesthesia. The aim of the study was to compare local and general anaesthesia in carotid artery surgery in order to establish whether differences exist in terms of peri-operative results, use of intra-operative shunts and costs.


METHODS
We retrospectively reviewed the data on 426 patients who underwent carotid endarterectomy with either local or general anaesthesia at our institution over a four-year period. All available clinical, pathologic and postoperative data were reviewed and analyzed for postoperative results. Surgical indications, outcome, operative techniques, and complications were compared.


RESULTS
A total of 306 carotid endarterectomy operations under local, and 127 under general anaesthesia were performed and analyzed. Groups were similar in terms of age, sex and pre-operative risk factor distribution. The local anaesthesia group was associated with a lower incidence of shunt placement and operative time when compared to the general anaesthesia group. Postoperative intensive care unit requirement, hospital stay and costs were also lower with local anaesthesia. Significant difference in neurological complications and mortality rate was not observed between the two groups.


CONCLUSIONS
Carotid endarterectomy performed under local or general anaesthesia is associated with low morbidity and mortality rates. Local anaesthesia enables the surgeon to assess the neurological status during the procedure. It is also associated with decreased shunt usage, decreased operative time and, in high risk patients, lower intensive care unit requirement and hospital stay.
Kalko
Y
Y
BEZM-I Alem Vakif Gureba Hospital, Cardiovascular Surgery Service, Capa/Istanbul, Turkey. ykalko@yahoo.com
Kafali
E
E
Aydin
U
U
Kafa
U
U
Kosker
T
T
Basaran
M
M
Ugurlucan
M
M
Nargileci
E
E
Yasar
T
T
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000191:economics; D000772:Anesthesia, Local / Q000191:economics; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014421:Turkey