Hemodynamics and jugular venous oxygen saturation during carotid endarterectomy: a comparison between general and locoregional anesthesia.
OBJECTIVE
To study hemodynamic and blood oxygenation changes in patients undergoing carotid endarterectomy (CEA) under general (GA) or locoregional (LRA) anesthesia.


METHODS
Prospective non-randomized study including 50 patients undergoing CEA (31 men, mean age 72 (range 50-84) years-old under GA (N.=23) or LRA (N.=27). Systemic blood pressure, ECG, venous oxygen saturation in the ipsilateral jugular bulb and pulse-oximetry were monitored. Blood-gas analysis was done from blood obtained from the radial artery and ipsilateral jugular vein.


RESULTS
Pulse rate and systemic systolic blood pressure were higher in LRA compared to the GA before, during and after cross clamping (P<0.05). Seven GA patients required dopamine-infusion to maintain systolic blood pressure >120 mmHg. Jugular venous saturation was initially identical in both groups, but decreased significantly upon cross clamping in LRA compared to GA (P<0.05). This difference remained at least 3 minutes after cross clamp release (P<0.05).


CONCLUSIONS
Patients under LRA seem to have increased sympathetic activity compared to patients under GA, as expressed by higher pulse rates and systolic blood pressures. Jugular venous saturation was lower during clamping of LRA patients. The differences were small and concur with the near-equality findings in studies analysing the clinical outcome.
Dias
N V
NV
Vascular Center Malmö-Lund, Malmö University Hospital, Malmö, Sweden. nuno.dias@med.lu.se
Kölbel
T
T
Gonçalves
I
I
Chew
M
M
Wistrand
J
J
Brunkwall
P S
PS
D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000008:administration & dosage; D016893:Carotid Stenosis / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D003250:Constriction; D004298:Dopamine / Q000008:administration & dosage; D016894:Endarterectomy, Carotid; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D010100:Oxygen; D004298:Dopamine