Advertisement

Regional Anesthesia is Preferable for Patients Undergoing Carotid Endarterectomy

  • Pierre Casthely
  • John Dluzneski

Abstract

Strokes are the third leading cause of death in North America [1]. They usually result from arterial occlusive disease involving the extracranial or intracranial vessels, or both, in 80% of the cases; 35%–40% of the patients with cerebrovascular insufficiency have significant intracranial vascular disease [2]. The site of occlusion may be extracranial or intracranial. Cerebral ischemia can be produced either by embolic infarction or by reducing cerebral perfusion. The source of most of the embolic material producing transient ischemic attacks (TIAs) and stroke appears to be platelet and fibrin—platelet casts, formed at the site of an atherosclerotic plaque, which then migrate into the intracranical vessels. This is the reasoning behind using aspirin, which inhibits platelet aggregation, in that group of patients.

Keywords

Cerebral Blood Flow Regional Anesthesia Carotid Endarterectomy Transverse Process Somatosensory Evoke Potential 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Cutler RWP: Neurology. In: Rubenstein E, Feldman DD (eds) Scientific American medicine, vol IIX. Scientific American, New York, 1981, pp 1–4.Google Scholar
  2. 2.
    Merrit HH: A textbook of neurology. Lea and Febiger, Philadelphia, 1979, pp 163–205.Google Scholar
  3. 3.
    Kannell WB, Wolf PA, McGee DL, Dawber TR, McNamara P, Castelli WP: Systolic blood pressure, arterial rigidity, and risk of stroke: the Framingham Study. JAMA 245:1225–1229, 1981.CrossRefGoogle Scholar
  4. 4.
    Freis ED: The Veterans Administration cooperative study on antihypertensive agents: implications for stroke prevention. Stroke 5:76–77, 1974.PubMedCrossRefGoogle Scholar
  5. 5.
    McDowell FH: Prevention of subsequent infarctions and transient ischemic attacks. Adv Neurol 25:277–286, 1979.PubMedGoogle Scholar
  6. 6.
    Evans WE, Cooperman M: The significance of asymptomatic unilateral carotid bruits in preoperative patients. Surgery 83:521–522, 1978.PubMedGoogle Scholar
  7. 7.
    Barnes RW, Marszalek PB: Asymptomatic carotid disease in the cardiovascular surgical patient: is prophylactic endarterectomy necessary? Stroke 12:497–500, 1981.PubMedCrossRefGoogle Scholar
  8. 8.
    Fitch W: Anaesthesia for carotid artery surgery. Br J Anaesth 48:591–796, 1976.CrossRefGoogle Scholar
  9. 9.
    Bland JE, Chapman RD, Wylie EJ, et al.: Neurological complications of carotid artery surgery. Ann Surg 171:459, 1979.CrossRefGoogle Scholar
  10. 10.
    Galbraith JG: Safeguards in carotid surgery. Surgery 63:1019, 1968.PubMedGoogle Scholar
  11. 11.
    Boysen G: Cerebral hemodynamics in carotid surgery. Acta Neurol Scand 52:1, 1973.Google Scholar
  12. Hoedt-Rasmussen K: Regional cerebral blood flow: the intraarterial injection method [thesis]. Acta Neurol Scand [Suppl 27], 1967.Google Scholar
  13. 13.
    Hoedt-Rasmussen K, Sveinsdottie E, Lassen NA: Regional cerebral blood flow in man determined by intraarterial injection of radioactive inert gas. Circ Res 18:237, 1966.PubMedGoogle Scholar
  14. 14.
    Kogure K, Scheinberg P, Fugishima M, et al.: Effects of hypoxia on cerebral autoregulation. Am J Physiol 219:1393, 1970.PubMedGoogle Scholar
  15. 15.
    Sundt TM, Sandok BA, Whisnant JP: Carotid endarterectomy: complications and preoperative assessment of risk. Mayo Clin Proc 50:301–306, 1975.PubMedGoogle Scholar
  16. 16.
    Ackerman RH: Non-invasive carotid evaluation. Stroke 11:675–678, 1980.PubMedCrossRefGoogle Scholar
  17. 17.
    Larson CP Jr, Ehrenfeld WK, Wade JG, et al.: Jugular venous oxygen saturation as an index of adequacy of cerebral oxygenation. Surgery 62:31, 1967.Google Scholar
  18. 18.
    Sundt TM Jr, Sharbrough FW, Piepgras DG, Kearns TP, Messick JM Jr, O’Fallon WM: Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc 56:533–543, 1981.PubMedGoogle Scholar
  19. 19.
    Hertzer NR, Beven EG, Greenstreet RL, Humphries AW: Internal carotid artery back pressure, intraoperative shunting, ulcerated atheromata, and the incidence of stroke during carotid endarterectomy. Surgery 83:306–312, 1978.PubMedGoogle Scholar
  20. 20.
    Pearce HJ, Becchetti JJ, Brown JH: Supraorbital photoplethysmographic monitoring during carotid endarterectomy with the use of an internal shunt: an added dimension of safety. Surgery 87:339–342, 1980.PubMedGoogle Scholar
  21. 21.
    Astrup J, Syman L, Branstron NM, et al.: Cortical evoked potential and extracellular K+ and H+ at critical levels of brain ischemia. Stroke 8:51–57, 1977.PubMedCrossRefGoogle Scholar
  22. 22.
    Lyons C, Clark LC, McDowell H, et al.: Cerebral venous oxygen content during carotid thrombinectomy. Ann Surg 160:561, 1964.PubMedCrossRefGoogle Scholar
  23. 23.
    Waltz AG, Sundt TM, Michenfelder JD: Cerebral blood flow, jugular venous \({{\text{P}}_{C{O_2}}}\) and lactate concentration and arterial-venous oxygen content during carotid endarterectomy. Eur Neurol 6:346, 1971/72.PubMedCrossRefGoogle Scholar
  24. 24.
    Galbraith JG, McDowall HA: Stroke and occlusive cerebrovascular disease: review and surgical results in 265 cases. J Med Assoc State Ala 38:1107, 1969.PubMedGoogle Scholar
  25. 25.
    Meyer JA, Gotoh F, Favale E: Effects of carotid compression on cerebral metabolism and electroencephalogram. Electroencephalogr Clin Neurophysiol 19:362, 1965.PubMedCrossRefGoogle Scholar
  26. 26.
    Toole JF, Siekert RG, Whisnant JP (eds): Cerebral vascular diseases: transactions of the sixth conference held under the auspices of the American Neurological Association and the American Heart Association Council on Cerebrovascular Disease. Grune and Stratton, New York, 1968.Google Scholar
  27. 27.
    Stern WE: Circulatory adequacy attendant upon carotid artery occlusion. Arch Neurol 21:455, 1969.PubMedGoogle Scholar
  28. 28.
    Thompson JE, Talkington CM: Carotid endarterectomy. Ann Surg 184:1, 1976.PubMedCrossRefGoogle Scholar
  29. 29.
    Waltz AG: Regional blood flow: responses to changes in arterial pressure and CO2 tension. In: Toole JF, Siekert RG, Whisnant JP (eds) Cerebral vascular disease. Grune and Stratton, New York, 1968, pp 66–76.Google Scholar
  30. 30.
    Agnoli A, Fieschi C, Prencipe M, et al.: rCBF studies during carotid surgery. In: Rüssel RWR (ed) Brain and blood flow. Pitman, London, 1971, pp 346–350.Google Scholar
  31. 31.
    Boysen G: Cerebral blood flow measurement as a safeguard during carotid endarterectomy. Stroke 2:1, 1971.PubMedCrossRefGoogle Scholar
  32. 32.
    Boysen G, Engell HC, Henriksen H: Effect of induced hypertension on internal carotid artery pressure and regional cerebral blood flow during temporary carotid clamping for endarterectomy. Neurology 22:1133, 1972.PubMedGoogle Scholar
  33. 33.
    Fourcade HE, Larson CP Jr, Ehrenfeld WK, et al.: The effects of CO2 and systemic hypertension on cerebral perfusion during carotid endarterectomy. Anesthesiology 33:383, 1970.PubMedCrossRefGoogle Scholar
  34. 34.
    Boysen G, Ladegaard-Pedersen HG, et al.: The effects of Paco2 on regional cerebral blood flow and internal carotid artery pressure during carotid clamping. Anesthesiology 35:286, 1971.PubMedCrossRefGoogle Scholar
  35. 35.
    Larson CP Jr: Anesthesia and the control of cerebral circulation. In: Wylie EJ, Ehrenfeld WK (eds) Extracranial occlusive cerebrovascular disease. WB Saunders, Philadelphia, 1970, pp 152–183.Google Scholar
  36. 36.
    Grundy BL: Monitoring of sensory evoked potentials during neurosurgical operations: methods and applications. Neurosurgery 11:556–573, 1982.PubMedCrossRefGoogle Scholar
  37. 37.
    Grays Anatomy, Warwick and Williams 35th British Edition. WB Saunders, Philadelphia, 1973.Google Scholar
  38. 38.
    Carron H, Korbonm G, Rowlingson J (eds): Regional anesthesia. Grune and Stratton, New York, 1984.Google Scholar
  39. 39.
    Winnie AP: Interscalene brachial block. Anesth Analg 49:455–456, 1970.PubMedCrossRefGoogle Scholar
  40. 40.
    Cousins M, Bridenbaug P (eds) Neural blockade. JB Lippincott, 1980.Google Scholar
  41. 41.
    Spielberger L, Turndorf H, Culliford A, Imparato A: Hand held toy squeaker during carotid endarterectomy in the awake patient. Arch Surg 114:103–104, 1979.PubMedGoogle Scholar
  42. 42.
    Prough DS, Scuderi PE, Stullken E, et al.: Myocardial infarction following regional anesthesia for carotid endarterectomy. Can Anaesth Soc J 31:192, 1984.PubMedCrossRefGoogle Scholar
  43. 43.
    Tarhan S, Moffitt EA, Taylor WF, et al.: Myocardial infarction after general anesthesia. JAMA 220:1451, 1972.PubMedCrossRefGoogle Scholar
  44. 44.
    Prys-Robert C: Hypertension and anesthesia: fifty years on [editorial]. Anesthesiology 50: 218–214, 1979.CrossRefGoogle Scholar
  45. 45.
    Rubio PA, Guinn GA: Myocardial infarction following carotid endarterectomy. Cardiovasc Dis 2:402–404, 1975.PubMedGoogle Scholar
  46. 46.
    Riles TS, Kopelman I, Imparato AM: Myocardial infarction following carotid endarterectomy: a review of 683 operations. Surgery 85:249–252, 1979.PubMedGoogle Scholar
  47. 47.
    Asiddao CB, Donegan JH, Whitsell RC, et al.: Factors associated with perioperative complications during carotid endarterectomy. Anesth Analg 61:631, 1982.PubMedCrossRefGoogle Scholar
  48. 48.
    Ranson JHC, Imparato AN, Caluss RH, et al.: Factors in the mortality and morbidity associated with surgical treatment of cerebrovascular insufficiency. Circulation [Suppl 1] 39–40: 269–274, 1969.Google Scholar
  49. 49.
    Wade JG, Larson CP Jr, Hickey RF, et al.: Effect of carotid endarterectomy on carotid che-moreceptor and baroreceptor function in man. N Engl J Med 282:823, 1970.PubMedCrossRefGoogle Scholar
  50. 50.
    Wade HG: Anesthesia for carotid endarterectomy: annual refresher course lecture, no. 208, 1972. American Society of Anesthesiologists Annual Meeting, Boston, 1972.Google Scholar
  51. 51.
    Bosiljevac J, Farha J: Carotid endarterectomy: results using regional anesthesia. Am Surg 46:403–408, 1980.PubMedGoogle Scholar
  52. 52.
    Connolly JE: Carotid endarterectomy in the awake patient. Am J Surg 150:159–164, 1985.PubMedCrossRefGoogle Scholar
  53. 53.
    Imparato AM, Ramirez A, Riles T, Mintzer R: Cerebral protection in carotid surgery. Arch Surg 117:1073–1078, 1982.PubMedGoogle Scholar
  54. 54.
    Yared I, Martinis A, Mack R: Carotid endarterectomy under local anesthesia: a retrospective study. Am Surg 45:709–71, 1979.PubMedGoogle Scholar
  55. 55.
    Shifrin E, Gertel M, Anner H, Olshwang D, Levy P: Local anesthesia in carotid endarterectomy: an alternative method. Isr J Med Sci 21:511–513, 1985.PubMedGoogle Scholar
  56. 56.
    Fourcade HE, Larson CP, Ehrenfeld WK, Hickey RF, Newton TH: The effects of CO2 and systemic hypertension on cerebral perfusion pressure during carotid endarterectomy. Anesthesiology 33:383, 1970.PubMedCrossRefGoogle Scholar
  57. 57.
    Gabelman C, Gann D, Ashworth C, Carney AL: One hundred consecutive carotid reconstructions: local versus general anesthesia. Am J Surg 145:477–471, 1983.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers, Boston 1988

Authors and Affiliations

  • Pierre Casthely
  • John Dluzneski

There are no affiliations available

Personalised recommendations