title: Regional anesthesia for carotid surgery: less intraoperative hypotension and vasopressor requirement.
abstract: Regional anesthesia (RA) is the gold standard of neuromonitoring during carotid endarterectomy (CEA). Recent data show that RA for CEA is associated with fewer postoperative complications. The aim of the present study was to assess hemodynamic stability and vasoactive drug use for CEA performed under RA versus general anesthesia (GA). All patients undergoing CEA from January 2005 to January 2006 were identified from our prospective database. Electronic and paper charts were reviewed. Intraoperative monitoring data were reviewed retrospectively. Hypotension was defined as systolic blood pressure (SBP) <100 mm Hg and deemed prolonged if it lasted more than 10 min. Hypertension was defined as SBP >160 mm Hg. BP variation was defined as the difference between the highest and lowest SBP, and bradycardia as heart rate (HR) below 60. The data were expressed as means +/- standard deviation. Seventy-two consecutive patients underwent CEA: 25 under RA and 47 under GA. There was no difference in preoperative HR and BP. Most patients had symptomatic severe carotid stenosis (80% in RA vs. 85% in GA, nonsignificant). Intraoperatively, RA was associated with less BP variation (60 +/- 27 vs. 78 +/- 22 mm Hg, p = 0.005), bradycardia (5% vs. 63%, p < 0.001), hypotension (20% vs. 70%, p < 0.01), and prolonged hypotension (0% vs. 23%, p = 0.009) and more hypertension (80% vs. 47%, p = 0.007). Vasopressor requirements were less frequent under RA (20% vs. 77%, p < 0.001). There was no significant difference between groups in hypotension or hypertension episodes seen in the postoperative recovery room. RA was associated with less hypotension and less vasopressor used during CEA compared to GA. The improved hemodynamic stability may account for the lower incidence of complications after CEA.
authors.affiliation: Vascular Surgery Service, Centre hospitalier de l'Université de Montréal-Hôtel-Dieu, Montreal, Quebec, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Jacques
authors.forename: Stéphane
authors.initials: S
authors.lastname: Elkouri
authors.forename: David
authors.initials: D
authors.lastname: Bracco
authors.forename: Thomas
authors.initials: T
authors.lastname: Hemmerling
authors.forename: Véronique
authors.initials: V
authors.lastname: Daniel
authors.forename: Nathalie
authors.initials: N
authors.lastname: Beaudoin
authors.forename: Luc
authors.initials: L
authors.lastname: Bruneau
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Blair
mesh_terms: D000368:Aged; D000765:Anesthesia, Conduction / Q000009:adverse effects; D000768:Anesthesia, General / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D001919:Bradycardia / Q000209:etiology / Q000517:prevention & control; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents