Perioperative outcome of carotid endarterectomy with regional anesthesia: two decades of experience from the Caribbean.
OBJECTIVE
To evaluate the perioperative outcome of carotid endarterectomy (CEA) with regional anesthesia.


METHODS
Retrospective chart review of consecutive patients who underwent CEA with regional anesthesia in a 23-year period.


METHODS
Operating rooms of a general hospital in a developing country.


METHODS
Demographic data, perioperative clinical data, postoperative morbidity and unplanned admissions were recorded.


RESULTS
A total of 183 CEA procedures were performed. In 172 cases, CEA was done exclusively with deep cervical plexus block and local infiltration, while in 11 (6%) cases, there was a need for conversion to general anesthesia intraoperatively. Clamping of the internal carotid artery (ICA) for a three-minute period was the method used to monitor any development of neurological impairment. Perioperative complications included intraoperative seizures in one patient, intraoperative transient hemiparesis in three patients, postoperative transient hemiparesis in two patients, and intraoperative hemiplegia in one patient. One hundred fifty-three patients (83.6%) were discharged home within 24 hours, and 29 (15.8%) were discharged home in 48 hours. The hemiplegic patient had a hospital stay of 12 days. There was no perioperative mortality.


CONCLUSIONS
Regional anesthesia is a safe method for CEA in a limited-resources setting, as it facilitates intraoperative clinical assessment of the effects of ICA clamping.
Hariharan
Seetharaman
S
The University of the West Indies, St. Augustine, Trinidad, West Indies, Trinidad and Tobago. uwi.hariharan@gmail.com
Naraynsingh
Vijay
V
Esack
Azad
A
Ramdass
Michael J
MJ
Teelucksingh
Surujpaul
S
Naraynsingh
Aroon
A
D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction / Q000379:methods*; D000768:Anesthesia, General / Q000706:statistics & numerical data; D017691:Caribbean Region / Q000453:epidemiology; D002572:Cervical Plexus; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010351:Patient Discharge / Q000706:statistics & numerical data; D019990:Perioperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome