The impact of anesthetic modality on the outcome of carotid endarterectomy

Carotid endarterectomy (CEA) reduces the risk of stroke in patients with high-grade carotid artery stenosis. This study evaluates the clinical outcome of CEA performed under local anesthesia (LA) versus general anesthesia (GA). Clinical variables and treatment outcomes were analyzed in 548 CEAs perf...

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Bibliographic Details
Published in:	The American journal of surgery Vol. 188; no. 6; pp. 741 - 747
Main Authors:	Watts, Ken, Lin, Peter H., BushM.D., Ruth L., Awad, Samir, McCoy, Sally A., Felkai, Deborah, Zhou, Wei, Nguyen, Liz, Guerrero, Marlon A., Shenaq, Salwa A., Lumsden, Alan B.
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-12-2004 Elsevier Limited
Subjects:	Age Distribution Aged Analysis of Variance Anesthesia Anesthesia, General - adverse effects Anesthesia, General - methods Anesthesia, Local - adverse effects Anesthesia, Local - methods Blood pressure Cardiovascular disease Carotid endarterectomy Carotid Stenosis - diagnosis Carotid Stenosis - mortality Carotid Stenosis - surgery Complications Endarterectomy, Carotid - methods Endarterectomy, Carotid - mortality Female Follow-Up Studies Heart attacks Heart failure Hospitals Humans Hypertension Intubation Ischemia Local anesthesia Male Medical imaging Middle Aged Mortality Multivariate Analysis Pain, Postoperative - epidemiology Pain, Postoperative - physiopathology Postoperative Complications - epidemiology Probability Prospective Studies Risk Factors Sex Distribution Statistics, Nonparametric Stroke Survival Analysis Treatment Outcome Veins & arteries Complications Carotid endarterectomy Local anesthesia
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Summary:	Carotid endarterectomy (CEA) reduces the risk of stroke in patients with high-grade carotid artery stenosis. This study evaluates the clinical outcome of CEA performed under local anesthesia (LA) versus general anesthesia (GA). Clinical variables and treatment outcomes were analyzed in 548 CEAs performed under either LA or GA during a 30-month period. Factors associated with morbidity were also analyzed. A total of 263 CEAs under LA and 285 CEA under GA were analyzed. The LA group was associated with a lower incidence of shunt placement, operative time, and perioperative hemodynamic instability compared to the GA group. No differences in neurologic complications or mortality were found between the 2 groups. Hyperlipidemia was a risk factor for postoperative morbidity in both the LA and GA groups, while age greater than 75 years was associated with increased overall morbidity in the GA group but not the LA group. This study demonstrates that increased age is associated with increased morbidity in CEA under GA, while hyperlipidemia is associated with increased morbidity in CEA regardless of the anesthetic choice.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0002-9610 1879-1883
DOI:	10.1016/j.amjsurg.2004.08.048