Superficial temporal artery-middle cerebral artery bypass using local anesthesia and a sedative without endotracheal general anesthesia.
OBJECTIVE
Superficial temporal artery (STA)-middle cerebral artery (MCA) bypasses have continually evolved, and new strategies have been advocated for reducing anesthetic or surgical morbidity and mortality. Further simplifying, and decreasing the invasiveness of, STA-MCA bypass by performing this operation without endotracheal general anesthesia was believed to be feasible in certain subsets of patients.


METHODS
The authors performed STA-MCA bypass using local anesthesia with a sedative in 10 patients with hemodynamically compromised occlusive cerebrovascular disease, as well as multiple comorbidities, between February 2010 and September 2011. The technique is based on the preoperative identification of the point at which the donor and recipient vessels are in closest proximity. Preoperative use of CT angiography allowed the authors to identify the target point precisely and use a minimally invasive procedure. All patients received dexmedetomidine as the sole sedative agent, together with scalp-blocking local anesthesia, with an unsecured airway.


RESULTS
Successful STA-MCA bypass surgeries were achieved via a preselected minimally invasive approach in all cases. There was good hemodynamic stability throughout surgery. No airway or ventilation complications occurred, and no patients were converted to general anesthesia. Subjectively, patients tolerated the technique well with a high rate of satisfaction. There were no perioperative morbidities or deaths. Postoperative MR angiography confirmed a patent bypass in all patients. All patients remained symptom free and returned to normal daily life following the operation.


CONCLUSIONS
This initial experience confirms the feasibility of performing STA-MCA bypass without endotracheal general anesthesia. This novel technique produced a high degree of patient satisfaction.
Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan. kaku@murakami.asahi-u.ac.jp
Yasuhiko
Y
Kaku
Kentaro
K
Yamashita
Jouji
J
Kokuzawa
Kiyomitsu
K
Kanou
Masanori
M
Tsujimoto
D000368:Aged; D000369:Aged, 80 and over; D000770:Anesthesia, Endotracheal; D000768:Anesthesia, General; D000772:Anesthesia, Local; D002343:Carotid Artery, Internal / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000379:methods*; D016292:Procedural Sedation; D020927:Dexmedetomidine; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives; D021621:Imaging, Three-Dimensional; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis / Q000601:surgery; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed
D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine