Wake-up test decrease shunts insertion during carotid endarterectomy under general anesthesia.
OBJECTIVE
The use of locoregional anesthesia versus general anesthesia (GE) in carotid endarterectomy (CEA) has been a debatable issue in clinical studies for the past several years. In our study, GE with wake-up tests (WUTs) during carotid cross-clamping was used instead of stump pressure (SP) to directly assess the neurological status of the patient to determine whether shunting was needed. Our study assessed the percentage of patients under light sedation and mechanically ventilated needing shunting based on WUT compared to a systolic stump pressure (SPs) cutoff value of <or=40 mm Hg.


METHODS
Retrospective, observational study.


METHODS
University hospital clinic.


METHODS
Three hundred fifty-one patients (American Society of Anesthesiologists physical class II-III) with carotid artery stenosis scheduled for CEA under GE.


METHODS
The WUT was used to assess the neurological status in patients undergoing CEA, which involved the gradual reduction of depth of anesthesia until the patient was capable of responding to a verbal stimulus and provide full collaboration while only receiving remifentanil. A positive WUT indicated that patient was not able to carry out the order.


RESULTS
Of 343 patients, 20 (5.8%) were shunted due to a positive WUT after cross-clamping in comparison to 45 patients (12.8%) based on the SPs <or=40 mm Hg criteria.


CONCLUSIONS
Wake-up test can be used to directly assess the neurological status in patients undergoing CEA to determine whether shunting is required. Our results showed that less patients required shunting based on WUT compared to the SP criteria.
Vetrugno
Luigi
L
Cardiothoracic and Vascular Anesthesia, University-Hospital of Udine, Udine, Italy. vetrugnoluigi@katamail.com
Di Luca
Elena
E
Drigo
Daniela
D
Fregonese
Valtiero
V
Gonano
Nevio
N
Giordano
Francesco
F
D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D001794:Blood Pressure; D001795:Blood Pressure Determination; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009460:Neurologic Examination; D010880:Piperidines / Q000008:administration & dosage; D011237:Predictive Value of Tests; D015742:Propofol / Q000008:administration & dosage; D000077208:Remifentanil; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D014851:Wakefulness
D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol