title: Effect of Superficial Cervical Plexus Block on Baroreceptor Sensitivity in Patients Undergoing Carotid Endarterectomy.
abstract: OBJECTIVE
  Regional anesthesia for patients undergoing carotid endarterectomy is associated with improved intraoperative hemodynamic stability compared with general anesthesia. The authors hypothesized that the reported advantages might be related to attenuated ipsilateral baroreflex control of blood pressure, caused by chemical denervation of the carotid bulb baroreceptor nerve fibers.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Single-center university hospital.
  
  
  METHODS
  The study included 46 patients undergoing carotid endarterectomy using superficial cervical block.
  
  
  METHODS
  A noninvasive computational periprocedural measurement of baroreceptor sensitivity was performed in all patients. Two groups were formed, depending on the patients' subjective response to surgical stimulation regarding the necessity of additional intraoperative local anesthesia (LA) administration on the carotid bulb. Group A (block alone) included 23 patients who required no additional anesthesia, and group B (block + LA) consisted of 23 patients who required additional anesthesia.
  
  
  RESULTS
  Baroreceptor sensitivity showed no significant change after application of the block in both groups (group A: median [IQR], 5.19 [3.07-8.54] v 4.96 [3.1-9.07]; p = 0.20) (group B: median [IQR], 4.47 [3.36-8.09] v 4.53 [3.29-8.01]; p = 0.55). There was a significant decrease in baroreceptor sensitivity in group B after intraoperative LA administration (median [IQR], 4.53 [3.29-8.01] v 3.31 [2.26-7.31]; p = 0.04).
  
  
  CONCLUSIONS
  Standard superficial cervical plexus block did not impair local baroreceptor function, and, therefore, it was not related to improved cerebral perfusion in awake patients undergoing carotid endarterectomy. However, direct infiltration of the carotid bulb was associated with the expected attenuation of baroreflex sensitivity.
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital of Heidelberg, Heidelberg, Germany;. Electronic address: serdar.demirel@med.uni-heidelberg.de.
authors.forename: Serdar
authors.initials: S
authors.lastname: Demirel
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital of Heidelberg, Heidelberg, Germany;
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Celi de la Torre
authors.affiliation: Department of Vascular and Thoracic Surgery, Augsburg City Hospital, University of Ludwig-Maximillians, Munich, Germany;
authors.forename: Hans
authors.initials: H
authors.lastname: Bruijnen
authors.affiliation: Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Eike
authors.initials: E
authors.lastname: Martin
authors.affiliation: Department of Anesthesiology, University Hospital of Heidelberg, Heidelberg, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Popp
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital of Heidelberg, Heidelberg, Germany;
authors.forename: Dittmar
authors.initials: D
authors.lastname: Böckler
authors.affiliation: Department of Vascular Surgery, City Hospital Triemli, Zurich, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Attigah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure; D066008:Cervical Plexus Block / Q000379:methods*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011311:Pressoreceptors; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local
keywords: baroreceptor sensitivity; carotid endarterectomy; superficial cervical plexus block