title: Preserved consciousness in general anesthesia during carotid endarterectomy: a six-year experience.
abstract: OBJECTIVE
  We prospectively evaluated safety and efficacy from our six-year results of general anesthesia (GA) using remifentanil conscious sedation in carotid endarterectomy (CEA).
  
  
  METHODS
  From January 2005 to December 2010, 625 consecutive CEAs were performed on 545 patients (male/female 336/209, age 75 ± 7 years). After a superficial plexus block with ropavacaine, GA was induced with an intravenous infusion of propofol, using local lidocaine during tracheal intubation and a high-dose of remifentanil, in all cases reducing and then stopping the remifentanil infusion at the clamping time so that the patient would be awake and collaborating within a few minutes, as in local anesthesia. Data on postoperative morbidity and mortality, neurological complications, shunt insertions and the responses to one-day and three-month questionnaires on satisfaction were collected for all patients.
  
  
  RESULTS
  The 30-day mortality was 0.32% (two patients). Only one major stroke (0.16%) and two minor strokes (0.32%) occurred. A shunt was deployed in 83 cases (13.3%). Eight patients (1.28%) reported cranial nerve injuries, and surgical drainage for postoperative hematoma was performed in 11 patients (1.8%). Thirty-one patients (4.6%) suffered postoperative nausea/vomiting. Almost all patients were satisfied at the 24-h (94.6%) and three-month (>98%) follow-up questionnaire.
  
  
  CONCLUSIONS
  The six-year results for GA using remifentanil conscious sedation were very satisfactory and highlighted the advantages of both GA (hemodynamic stability and excellent control of ventilation) and local anesthesia (ease of evaluation of neurological status) in a calm and relaxed environment for both patient and surgeon.
authors: Unit of Vascular and Endovascular Surgery, San Paolo Hospital, Civitavecchia, Rome, Italy. gmarcroma@alice.it
authors: Giustino
authors: G
authors: Marcucci
authors: Andrea
authors: A
authors: Siani
authors: Federico
authors: F
authors: Accrocca
authors: Roberto
authors: R
authors: Gabrielli
authors: Alessandro
authors: A
authors: Giordano
authors: Roberto
authors: R
authors: Antonelli
authors: Andrea
authors: A
authors: Sbroscia
authors: Federica
authors: F
authors: Mounayergi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000009:adverse effects; D002340:Carotid Artery Diseases / Q000601:surgery*; D016292:Procedural Sedation / Q000009:adverse effects; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007442:Intubation, Intratracheal; D007558:Italy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010880:Piperidines / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D000077208:Remifentanil; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil