Conclusions
Anaesthesia for carotid artery surgery is exacting and good results demand a strong team approach. I believe that the recent multicentre trials have given both surgeon and anaesthetist a touchstone with which they can compare their results. For instance, if your centre’s results are as good or better than the NASCET criteria (mortality of 0.6% and a stroke rate of 2.1%) then your team is performing at an acceptable level. If not, improvements in technique are desirable. Better results at one or more centres may point the way to optimal anaesthetic and surgical management. Regardless, the NASCET, ECST and ACAS studies should cause us to rethink our management of these cases to improve patient outcome. This is especially important because there has already been a dramatic increase in the frequency of this procedure. These studies should prompt those of us involved in the management of these difficult cases to conduct well conceived clinical trials to answer some of the controversies raised above. Only then will the risks of anaesthesia and surgery for this procedure be reduced to an absolute minimum based on sound scientific judgement.
Conclusions
L’anesthésie pour la chirurgie de la carotide est exigeante et pour obtenir de bons résultats, il faut travailler étroitement en équipe. Je crois que les études multicentriques récentes ont fourni une base solide tant au chirurgien qu’à l’anesthésiste sur laquelle la comparaison avec leurs propres résultats devient possible. Par exemple, si les résultats de votre institution sont comparables aux critères de NASCET ou les dépassent (mortalité de 0,6% et taux d’ACV de 2,1%), le niveau de performance de votre équipe est acceptable, sinon vos techniques doivent être révisées. Les autres centres qui rapportent de meilleurs résultats peuvent servir de modèles pour une gestion anesthésique et chirurgicale optimale. Abstraction faite de ces considérations, les études de NASCET, ECST et ACAS devraient nous inciter à repenser notre ligne de conduite dans le but d’améliorer l’avenir de nos patients. Ceci est particulièrement important étant donné l’augmentation dramatique de la fréquence de cette intervention. Ces études devraient aussi encourager ceux qui sont engagés dans la prise en charge de ces cas difficiles à mener des essais cliniques sérieux afin de participer à la solution des questions déjà mentionnées. C’est seulement à ce moment-là que les risques de l’anesthésie et de la chirurgie pourront être réduits à un minimum absolu basé sur un jugement clinique éclairé.
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Mutch, W.A.C. Anaesthesia for carotid artery surgery. Can J Anaesth 44 (Suppl 1), R90–R100 (1997). https://doi.org/10.1007/BF03022268
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DOI: https://doi.org/10.1007/BF03022268