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J Neurol Surg A Cent Eur Neurosurg 2019; 80(04): 250-254
DOI: 10.1055/s-0039-1678601
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Indications for General versus Local Anesthesia during Carotid Endarterectomy

Jan Mracek
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
,
Jakub Kletecka
2   Department of Anesthesia and Intensive Care Medicine, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
,
Jan Mork
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
,
David Stepanek
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
,
Jiri Dostal
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
,
Jolana Mrackova
3   Department of Neurology, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
,
Vladimir Priban
1   Department of Neurosurgery, Faculty of Medicine in Pilsen, Charles University, University Hospital Pilsen, Pilsen, Czech Republic
› Author Affiliations Funding Source This study was supported by the grant of Ministry of Health of the Czech Republic: Conceptual Development of Research Organization (Faculty Hospital in Pilsen–FNPl, 00669806).
Further Information

Publication History

03 August 2018

19 November 2018

Publication Date:
18 March 2019 (online)

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Abstract

Background and Study Aims Both general anesthesia (GA) and local anesthesia (LA) are used in our department for carotid endarterectomy. The decision of which anesthetic technique to use during surgery is made on an individual basis. The aim of our study was to analyze the reasons for using GA or LA.

Material and Methods The reasons that led to the selection of either GA or LA were analyzed retrospectively in a group of 409 patients.

Results GA was used in 304 patients (74%) and LA in 105 patients (26%). The reasons for a preference for GA were clopidogrel use (88 patients), patient preference (80), increased risk of shunt insertion (43), unfavorable anatomical conditions (41), surgeon preference (21), simultaneous carotid endarterectomy and cardiac surgery (18), emergent carotid endarterectomy (12), and sleep apnea syndrome (1). The reasons for selecting LA were internal comorbidities (46 patients), patient preference (39), unavailability of intraoperative electrophysiologic monitoring (15), and pacemaker (5).

Conclusion GA is the dominant choice for carotid endarterectomy in our department because of its prevailing benefits and its preference among neurosurgeons and patients. However, in some subgroups of patients, LA is preferable. An optimal approach is therefore an individual indication for both anesthesia techniques.

Keywords

carotid endarterectomy - general anesthesia - local anesthesia - indications
 

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