title: The impact of general versus local anesthesia on early subclinical cognitive function following carotid endarterectomy evaluated using P3 event-related potentials.
abstract: BACKGROUND
  Postoperative cognitive dysfunction (POCD) is detected in 25% of patients undergoing carotid endarterectomy (CEA). The mechanism of POCD is poorly understood, but it is believed that general anesthesia (GA) itself may contribute significantly to POCD. The aim of our prospective study was to compare, with the aid of event-related potentials, the impact of general anesthesia (GA) and local anesthesia (LA) on POCD in patients undergoing CEA.
  
  
  METHODS
  Sixty patients were included in this study and were divided into two groups: CEA was performed in 30 patients placed under GA (total intravenous anesthesia), herein the GA group, while 30 patients underwent CEA under LA (cervical plexus block), herein LA group. Cognitive outcome was assessed with the use of auditory event-related potentials (ERPs), P3 response. The measurements were taken before surgery (pre-op) and on the first (1.post-op) and the sixth postoperative days (6.post-op).
  
  
  RESULTS
  Preoperative cognitive functions did not differ significantly between the two groups. A significant decrease in P3 amplitude was found on the first postoperative day (1.post-op) in the GA group (p = 0.0005), but normalization of P3 amplitude was detected at the second postoperative measurement (6.post-op). The patients operated on under local anesthesia (LA group) showed stable P3 amplitudes in all three measurements. No significant changes in P3 latencies were observed in either group. There were no significant differences between the two groups regarding demographic characteristics, preoperative and postoperative clinical condition, percentage significance of carotid artery stenosis, duration of carotid cross-clamping or in the frequency of shunt use (zero frequency for both groups).
  
  
  CONCLUSIONS
  Our study showed that general anesthesia, used for patients undergoing CEA, negatively influenced cognitive function during the immediate period after surgery (the first postoperative day). However, by the sixth postoperative day, this cognitive impairment was no longer being detected. POCD occurring shortly after carotid endarterectomy is the result of general anesthesia, which is probably an independent evoking factor in itself. The cognitive deficit recorded only during the immediate postoperative period, is not a negative effect of GA but merely a side-effect and thus GA should not be considered inferior to LA for use during CEA.
authors.affiliation: Department of Neurosurgery, University Hospital and Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, Pilsen, Czech Republic. mracek@fnplzen.cz
authors.forename: Jan
authors.initials: J
authors.lastname: Mracek
authors.forename: Irena
authors.initials: I
authors.lastname: Holeckova
authors.forename: Ivan
authors.initials: I
authors.lastname: Chytra
authors.forename: Jan
authors.initials: J
authors.lastname: Mork
authors.forename: David
authors.initials: D
authors.lastname: Stepanek
authors.forename: Petra
authors.initials: P
authors.lastname: Vesela
mesh_terms: D000368:Aged; D018681:Anesthetics, General / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods*; D018913:Event-Related Potentials, P300 / Q000187:drug effects* / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D011446:Prospective Studies
chemical_list: D018681:Anesthetics, General; D000779:Anesthetics, Local