Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Choice of anesthesia for carotid endarterectomy: the problemof assessing the risk of perioperative complications and the tacticsof anesthetic management in elderly patient with cardiological anamnesis

Authors: K.A. Kozlova, A.V. Shmigel’skiy, D.Yu. Usachev, V.A. Lukshin, O.M. Zelenkova

Company:
N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, ul. Chetvertaya Tverskaya-Yamskaya, 16, Moscow, 125047, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2019-16-3-228-234

UDC: 616.133.3:616.147]-053.9-089.87:616.12-089.5:615.849

Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (3): 228-234

Quote as: Kozlova K.A., Shmigel’skiy A.V., Usachev D.Yu., Lukshin V.A., Zelenkova O.M. Choice of anesthesia for carotid endarterectomy: the problem of assessing the risk of perioperative complications and the tactics of anesthetic management in elderly patient with cardiological anamnesis. Clinical Physiology of Circulation. 2019; 16 (3): 228–34 (in Russ.). DOI: 10.24022/1814-6910-2019-16-3-228-234

Received / Accepted:  17.06.2019/02.07.2019

Download
Full text:  

Abstract

The article presents the clinical observation of patient 78 years old, who entered the clinic with a diagnosis of cerebrovascular disease, stenosis of the internal carotid artery. To perform carotid endarterectomy (CEAE), combined anesthesia (CA) was first used: total intravenous anesthesia in combination with regional anesthesia – a superficial and deep blockade of the cervical plexus with local anesthetics. However, during the first hour from the start of induction of anesthesia, the patient developed a stable pharmacoresistant bradiarrhythmia, which required the termination of the operation, transfer of the patient to the intensive care unit. After the stabilization of his condition, the next day there was a reoperation in the regional anesthesia, spontaneous breathing and saved consciousness without any problems. The article discusses the problem of preoperative risk assessment of reoperative complications and indications for the choice of anesthesia method for CEAE.

References

  1. Lewis S.C., Warlow C.P., Bodenham A.R., Colam B., Rothwell P.M., Torgerson D. et al. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet. 2008; 372 (9656): 2132–42. DOI: 10.1016/s0140-6736(08) 61699-2
  2. Ladak N., Thompson J. General or local anaesthesia for carotid endarterectomy? Contin. Educ. Anaesth. Crit. Care Pain. 2012; 12 (2): 92–6. DOI: 10.1093/bjaceaccp/mkr061
  3. Leichtle S.W., Mouawad N.J., Welch K., Lampman R., Whitehouse W.M. Jr., Heidenreich M. Outcomes of carotid endarterectomy under general and regional anesthesia from the American College of Surgeons’ National Surgical Quality Improvement Program. J. Vasc. Surg. 2012; 56 (1): 81–3. DOI: 10.1016/j.jvs.2012.01.005
  4. Vaniyapong T., Chongruksut W., Rerkasem K. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst. Rev. 2013; 12: CD000126. DOI: 10.1002/14651858
  5. Calik E., Arslan U., Erkut B. Which anesthesia for carotid endarterectomy: local or general? Anaesth. Anaesthet. 2018; 2 (1): 1–2. DOI: 10.15761/JAA.1000109
  6. Hajibandeh S., Hajibandeh S., Torella F., Antoniou G., Antoniou S.A. Meta-analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy. Anaesthesia. 2018; 73 (10): 1280–9. DOI: 10.1111/anae.14320
  7. Patelis N., Diakomi M., Maskanakis A., Maltezos K., Schizas D., Papaioannou M. General versus local anesthesia for carotid endarterectomy: special considerations. Saudi J. Anaesth. 2018; 12 (4): 612–7. DOI: 10.4103/sja.SJA_10_18
  8. Hussain A.S., Mullard A., Oppat W.F., Nolan K.D. Increased resource utilization and overall morbidity are associated with general versus regional anesthesia for carotid endarterectomy in data collected by the Michigan Surgical Quality Collaborative. J. Vasc. Surg. 2017; 66 (3): 802–9. DOI: 10.1016/j.jvs.2017.01.060
  9. Liu J., Martinez-Wilson H., Neuman M.D., Elkassabany N., Ochroch E.A. Outcome of carotid endarterectomy after regional anesthesia versus general anesthesia – a retrospective study using two independent databases. Transl. Perioper. Pain Med. 2014; 1 (2): 14–21. PMC 4444227
  10. Knappich C., Kuehnl A., Tsantilas P., Schmid S., Breitkreuz T., Kallmayer M. et al. Intraoperative completion studies, local anesthesia, and antiplatelet medication are associated with lower risk in carotid endarterectomy. Stroke. 2017; 48 (4): 955–62. DOI: 10.1161/strokeaha.116.014869
  11. Siu A., Patel J., Prentice H.A., Cappuzzo J.M., Hashemi H., Mukherjee D. A cost analysis of regional versus general anesthesia for carotid endarterectomy. Ann. Vasc. Surg. 2017; 39: 189–94. DOI: 10.1016/j.avsg.2016.05.124
  12. Pasin L., Nardelli P., Landoni G., Cornero G., Magrin S., Tshomba Y. et al. Examination of regional anesthesia for carotid endarterectomy. J. Vasc. Surg. 2015; 62 (3): 631–4.e1. DOI: 10.1016/j.jvs.2015.03.074
  13. Samanta S., Samanta S., Panda N., Haldar R. A unique anesthesia approach for carotid endarterectomy: combination of general and regional anesthesia. Saudi J. Anaesth. 2014; 8 (2): 290–3. DOI: 10.4103/1658-354x.130753
  14. Messner M., Albrecht S., Lang W., Sittl R., Dinkel M. The superficial cervical plexus block for postoperative pain therapy in carotid artery surgery. A prospective randomised controlled trial. Eur. J. Vasc. Endovasc. Surg. 2007; 33 (1): 50–4. DOI: 10.1016/j.ejvs.2006.06.024
  15. Baldinelli F., Pedrazzoli R., Ebner H., Auricchio F. Asleep-awake-asleep technique during carotid endarterectomy: a case series. J. Cardiothorac. Vasc. Anesth. 2010; 24 (4): 550–4. DOI: 10.1053/j.jvca.2010.02.009
  16. Licker M. Regional or general anaesthesia for carotid endarterectomy: does it matter? Eur. J. Anaesthesiol. 2016; 33 (4): 241–3. DOI: 10.1097/eja.0000000000000376
  17. Guay J. The GALA trial: answers it gives, answers it does not. Lancet. 2008; 372 (9656): 2092–3. DOI: 10.1016/s0140-6736(08)61700-6
  18. Boulanger M., Camelière L., Felgueiras R., Berger L., Rerkasem K., Rothwell P.M., Touzé E. Periprocedural myocardial infarction after carotid endarterectomy and stenting: systematic review and meta-analysis. Stroke. 2015; 46 (10): 2843–8. DOI: 10.1161/strokeaha.115.010052
  19. Kakisis J.D., Antonopoulos C.N., Mantas G., Moulakakis K.G., Sfyroeras G., Geroulakos G. Cranial nerve injury after carotid endarterectomy: incidence, risk factors, and time trends. Eur. J. Vasc. Endovasc. Surg. 2017; 53 (3): 320–35. DOI: 10.1016/j.ejvs.2016.12.026
  20. Seidel R., Zukowski K., Wree A., Schulze M. Ultrasound- guided intermediate cervical plexus block and perivascular local anesthetic infiltration for carotid endarterectomy: a randomized controlled trial. Anaesthesist. 2016; 65 (12): 917–24. DOI: 10.1007/ s00101-016-0230-z
  21. Mądro P., Dąbrowska A., Jarecki J., Garba P. Anaesthesia for carotid endarterectomy. Ultrasound-guided superficial/intermediate cervical plexus block combined with carotid sheath infiltration. Anaesthesiol. Intensive Ther. 2016; 48 (4): 234–8. DOI: 10.5603/AIT.2016.0043
  22. Stoneham M.D., Thompson J.P. Arterial pressure management and carotid endarterectomy. Br. J. Anaesth. 2009; 102 (4): 442–52. DOI: 10.1093/bja/aep012
  23. Gomes M., Soares M.O., Dumville J.C., Lewis S.C., Torgerson D.J., Bodenham A.R. et al. Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery (GALA Trial). Br. J. Surg. 2010; 97 (8): 1218–25. DOI: 10.1002/bjs.7110
  24. Sheridan D.J., Julian D.G. Achievements and limitations of evidence-based medicine. J. Am. Coll. Cardiol. 2016; 68 (2): 204–13. DOI: 10.1016/j.jacc.2016.03.600
  25. Bevilacqua S., Romagnoli S., Ciappi F., Lazzeri C., Gelsomino S., Pratesi C., Gensini G.F. Anesthesia for carotid endarterectomy: the third option. Patient cooperation during general anesthesia. Anesth. Analg. 2009; 108 (6): 1929–36. DOI: 10.1213/ane.0b013e31819f6f7b
  26. Marcucci G., Siani A., Accrocca F., Gabrielli R., Giordano A., Antonelli R. et al. Preserved consciousness in general anesthesia during carotid endarterectomy: a sixyear experience. Interact. Cardiovasc. Thorac. Surg. 2011; 13 (6): 601–5. DOI: 10.1510/icvts.2011.280321
  27. Rerkasem K., Bond R., Rothwell P.M. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database Syst. Rev. 2004; 2: CD000126. DOI: 10.1002/14651858.cd000126.pub2
  28. Singh D. Locoregional anesthesia is better for carotid endarterectomy in our scenario. Indian J. Vasc. Endovasc. Surg. 2017; 4: 46–8. DOI: 10.4103/ijves.ijves_56_16

About Authors

  • Kseniya A. Kozlova, Anesthesiologist; orcid.org/0000-0002-7142-229X
  • Aleksandr V. Shmigel’skiy, Dr. Med. Sc., Senior Researcher; orcid.org/0000-0002-8349-7707
  • Dmitriy Yu. Usachev, Dr. Med. Sc., Professor, Corresponding Member of the Russian Academy of Sciences, Deputy Director for Research; orcid.org/0000-0003-1520-5650
  • Vasiliy A. Lukshin, Dr. Med. Sc., Associate Professor, Senior Researcher; orcid.org/0000-0001-5787-484X
  • Ol’ga M. Zelenkova, Functional Diagnostician; orcid.org/0000-0002-7579-3258

 If you found mistakes, select text and press Alt+A