Local Versus General Anaesthetic for Carotid Endarterectomy
2004; Lippincott Williams & Wilkins; Volume: 36; Issue: 1 Linguagem: Inglês
10.1161/01.str.0000149619.42677.e7
ISSN1524-4628
AutoresKittipan Rerkasem, Rick Bond, Peter M. Rothwell,
Tópico(s)Cardiac, Anesthesia and Surgical Outcomes
ResumoHomeStrokeVol. 36, No. 1Local Versus General Anaesthetic for Carotid Endarterectomy Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBLocal Versus General Anaesthetic for Carotid Endarterectomy Kittipan Rerkasem, MD, PhD, Rick Bond, MBBS, Dphil and Peter M. Rothwell, MD, PhD Kittipan RerkasemKittipan Rerkasem From the Department of Surgery (K.R.), Chiang Mai University, Chiang Mai, Thailand; and the Stroke Prevention Research Unit (R.B., P.M.R.), University of Oxford, Oxford, UK. , Rick BondRick Bond From the Department of Surgery (K.R.), Chiang Mai University, Chiang Mai, Thailand; and the Stroke Prevention Research Unit (R.B., P.M.R.), University of Oxford, Oxford, UK. and Peter M. RothwellPeter M. Rothwell From the Department of Surgery (K.R.), Chiang Mai University, Chiang Mai, Thailand; and the Stroke Prevention Research Unit (R.B., P.M.R.), University of Oxford, Oxford, UK. Originally published29 Nov 2004https://doi.org/10.1161/01.STR.0000149619.42677.e7Stroke. 2005;36:169–170Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: November 29, 2004: Previous Version 1 Carotid endarterectomy (CEA) markedly reduces the risk of stroke in people with recently symptomatic 70% to 99% carotid artery stenosis and to a lesser extent in people with 50% to 69% stenosis. However, benefit is dependent on maintaining a low operative risk, which may depend to some extent on the type of anesthetic used. Nonrandomized comparisons suggest that CEA under local anesthesia (LA) is associated with a lower operative risk of stroke and death than CEA under general anesthesia (GA), but such data are potentially unreliable and randomized studies are required.ObjectivesThe aim of this review was to assess the operative risks of CEA under LA compared with CEA under GA.Search StrategyTwo reviewers independently searched MEDLINE (1966 to April 2003), EMBASE (1980 to 2002), and Index to Scientific and Technical Proceedings (1980 to 1994). We also searched the Stroke Group trials register (April 2003), hand-searched 13 relevant journals up to 2002, and searched the reference lists of articles identified. We also advertised the review in Vascular News in August 2001.Selection CriteriaCriteria included randomized trials and nonrandomized studies comparing CEA under LA versus GA.Data Collection and AnalysisOne reviewer selected studies for inclusion and another independently checked the decisions. Two reviewers assessed trial quality and independently extracted the data.Main ResultsSeven randomized trials involving 554 operations and 41 nonrandomized studies involving 25 622 operations were included. Eleven of the nonrandomized studies were prospective and 29 reported on a consecutive series of patients, but the methodological quality of many of the nonrandomized trials was questionable. In 9 nonrandomized studies, the number of arteries, as opposed to the number of patients, was unclear. Meta-analysis of the nonrandomized studies showed that the use of local anesthetic was associated with significant reductions in the odds of death (35 studies), stroke (31 studies), stroke or death (26 studies), myocardial infarction (22 studies), and pulmonary complications (7 studies), within 30 days of the operation.Meta-analysis of the 7 randomized studies revealed a nonsignificant trend toward a reduced mortality within 30 days of the operation with LA (pooled OR, 0.23; 95% CI, 0.05 to 1.02), but this estimate was based on a very small number of events (Table). LA was, however, associated with a more convincing reduction in local postoperative hemorrhage (OR, 0.31; 95% CI, 0.12 to 0.79) within 30 days of the operation. There was no evidence of a difference in the odds of operative stroke. Pooled Absolute Risks and Odds of Complications After CEA From 7 Randomized Trials of CEA Performed Under LA vs GAOutcomeLAGAOR95% CIHeterogeneity, PEvent/OperationEvent/OperationOdds ratios were calculated by the standard Peto method.Heterogeneity of estimates between studies was calculated by the χ2 method.CI indicates confidence interval; MI, myocardial infarction; OR, odds ratio.All deaths1/2806/2740.230.05–1.020.7Stroke6/2806/2741.010.32–3.180.2Stroke and death7/28011/2740.630.25–1.620.3MI4/2805/2740.770.21–2.880.6Local hemorrhage4/22314/2210.310.12–0.790.6Nerve injury4/1672/1661.980.39–9.970.2Artery shunted56/22360/2210.680.40–1.14 1000 patients so far.Note: The full text of this review is available in the Cochrane Library (for subscribers: www.update-software.com/Cochrane). The full article should be cited as: Rerkasem K, Bond R, Rothwell PM. Local versus general anaesthetic for carotid endarterectomy (Cochrane Review). In: The Cochrane Library. Issue 2, 2004 Oxford: Update Software. 227 Cochrane Library, John Wiley & Sons Ltd.FootnotesCorrespondence to Prof Peter Rothwell, Stroke Prevention Research Unit, Department of Clinical Neurology, Radcliffe Infirmary, Woodstock Road, Oxford OX2 6HE, United Kingdom. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Dellaretti M, de Vasconcelos L, Dourado J, de Souza R, Fontoura R and de Sousa A (2016) Locoregional Anesthesia for Carotid Endarterectomy: Identification of Patients with Intolerance to Cross-Clamping, World Neurosurgery, 10.1016/j.wneu.2015.11.097, 87, (61-64), Online publication date: 1-Mar-2016. Dellaretti M, de Vasconcelos L, Dourado J, de Souza R, Fontoura R and de Sousa A (2016) The importance of internal carotid artery occlusion tolerance test in carotid endarterectomy under locoregional anesthesia, Acta Neurochirurgica, 10.1007/s00701-016-2789-1, 158:6, (1077-1081), Online publication date: 1-Jun-2016. Ackerman P and Loftus C (2014) Should We Adopt Micro-Interintimal Dissection: A Novel and Worthwhile Advance in Carotid Surgery Technique, but Does It Prevent Restenosis and Early Neurological Deficits?, World Neurosurgery, 10.1016/j.wneu.2013.02.074, 82:1-2, (e87-e89), Online publication date: 1-Jul-2014. Herrick I, Higashida R and Gelb A (2010) OCCLUSIVE CEREBROVASCULAR DISEASE Cottrell and Young's Neuroanesthesia, 10.1016/B978-0-323-05908-4.10021-1, (278-295), . Moneta G (2006) Local Versus General Anaesthetic for Carotid Endarterectomy, Yearbook of Vascular Surgery, 10.1016/S0749-4041(08)70233-1, 2006, (301-302), Online publication date: 1-Jan-2006. Pasternak J and Lanier W (2006) Neuroanesthesiology Review???2005, Journal of Neurosurgical Anesthesiology, 10.1097/00008506-200604000-00002, 18:2, (93-105), Online publication date: 1-Apr-2006. Evseev M, Chumachenko E, Plotnikov G and Shukevich D (2018) OPIOID-FREE ANESTHESIA FOR EXTRACRANIAL BYPASS SURGERIES IN PATIENTS WITH POLYVASCULAR DISEASE, Complex Issues of Cardiovascular Diseases, 10.17802/2306-1278-2018-7-3-94-101, 7:3, (94-101) January 2005Vol 36, Issue 1 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000149619.42677.e7 Manuscript receivedAugust 4, 2004Manuscript acceptedAugust 10, 2004Originally publishedNovember 29, 2004 PDF download Advertisement
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