Local versus general anesthesia for carotid endarterectomy: issues beyond stroke, myocardial infarction, and death rates.
Like the earlier multicenter General Anesthesia (GA) versus Local Anaesthesia (LA) for carotid surgery (GALA) trial, a recent independent study showed no difference in transient ischemic attack, stroke, myocardial infarction, and death rates between carotid endarterectomy (CEA) performed under LA compared with GA. Besides these outcomes, however, several additional issues may be of interest when comparing the 2 modalities. Examples include the occurrence of post-CEA patient delirium, cognitive dysfunction, and health-related quality of life, as well as the cost-effectiveness, length of hospitalization, and resource utilization. This commentary discusses and compares these outcomes of CEA performed under LA versus GA.
Department of Vascular and Endovascular Surgery, Klinikum Nürnberg Süd, Germany. paraskevask@hotmail.com
Kosmas I
KI
Paraskevas
Dimitri P
DP
Mikhailidis
Kyriakos
K
Oikonomou
Eric L
EL
Verhoeven
D000768:Anesthesia, General / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D016893:Carotid Stenosis / Q000601:surgery*; D002423:Cause of Death / Q000639:trends; D016894:Endarterectomy, Carotid; D014943:Global Health; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome