title: Anesthesia for carotid endarterectomy: the third option. Patient cooperation during general anesthesia.
abstract: BACKGROUND
  Carotid endarterectomy is typically performed using either regional or general anesthesia techniques, which exhibit several differences, especially regarding the intraoperative neurological monitoring of patients. In this study, we introduce a technique of general anesthesia (cooperative patient general anesthesia), which allows neurological monitoring of the awake patient during surgery.
  
  
  METHODS
  We prospectively enrolled 181 consecutive adult patients scheduled for carotid endarterectomy. Patients were anesthetized with a total i.v. anesthesia technique. During carotid clamping, anesthesia was reduced and maintained only with high-dose remifentanil, such that the patient was able to respond to verbal statements and neurological monitoring could be performed. The technique is described in detail. Patient neurological and cardiac outcomes were investigated. Patient and surgeon satisfaction with the technique were also evaluated.
  
  
  RESULTS
  General anesthesia with a cooperative patient was achieved in 179 patients. No postoperative neurological events were observed. Two (1.1%) nonfatal myocardial infarctions occurred in the early postoperative period in two patients. Eighty-one percent of patients described the operation duration as brief, whereas 19.3% accurately perceived the time they were conscious. Both patients and surgeons were highly satisfied with the technique.
  
  
  CONCLUSIONS
  In our series, cooperative patient general anesthesia proved to be a safe and satisfactory anesthetic technique for both the patient and surgeon. The technique was characterized by hemodynamic stability, excellent control of ventilatory pattern, continuous neurological monitoring, and immediate and safe conversion to general anesthesia whenever required. Further studies are needed to highlight the advantages of this technique compared with standard general and local anesthesia.
authors.affiliation: Heart and Vessel Department, Anesthesia and Postsurgical Intensive Care Unit, Azienda Ospedaliera Universitaria Careggi, Viale Morgagni 85, 50134, Firenze, Italy. sebevi@tin.it
authors.forename: Sergio
authors.initials: S
authors.lastname: Bevilacqua
authors.forename: Stefano
authors.initials: S
authors.lastname: Romagnoli
authors.forename: Francesco
authors.initials: F
authors.lastname: Ciappi
authors.forename: Chiara
authors.initials: C
authors.lastname: Lazzeri
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.forename: Carlo
authors.initials: C
authors.lastname: Pratesi
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001364:Awareness / Q000187:drug effects; D002985:Clinical Protocols; D016292:Procedural Sedation; D003250:Constriction; D016894:Endarterectomy, Carotid; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009422:Nervous System Diseases / Q000209:etiology; D010147:Pain Measurement; D010342:Patient Acceptance of Health Care; D011229:Preanesthetic Medication; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous