General anaesthesia versus cervical block and perioperative complications in carotid artery surgery

P. Fiorani, E. Sbarigia, F. Speziale, M. Antonini, B. Fiorani, L. Rizzo, M. Massucci

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To compare the influence of anaesthetic technique on perioperative complications in patients undergoing carotid endarterectomy. Material and methods: In a retrospective study of 1020 consecutive patients who underwent carotid artery surgery over 10 years, perioperative neurologic and cardiologic complications and the use of an internal carotid artery shunt were compared in 337 patients (33%) treated under general anaesthesia and 683 (67%) under cervical block. The two groups had similar characteristics. The most frequent surgical indication was symptomatic carotid artery disease (91.5%). The remaining patients had asymptomatic severe internal carotid lesions (> 70%). Results: The overall perioperative stroke rate was 1.9%, the death-stroke rate 0.7% and the cardiac complication rate 0.8%. The perioperative stroke rate was higher in the general anaesthesia group than in the cervical block group (3.2% vs 1.3%, p = 0.01). Cardiac complication rates were similar in the two groups. A carotid artery shunt was used in 75 patients (22%) receiving general anaesthesia and in 92 patients (13%) receiving cervical block (p = 0.0004). The causes of stroke in the cervical block group were intraoperative embolism (4 cases, 26%), perioperative thromboembolism (7 cases, 58%) and clamping ischaemia (I case, 16%). Mechanisms causing stroke in the general anaesthesia group remained unidentified or uncertain. Conclusions: Cervical block anaesthesia yields better perioperative results than general anaesthesia probably because it allows move reliable cerebral monitoring, reducing or even eliminating perioperative strokes related to clamping ischaemia. It facilitates detection of the mechanism underlying intraoperative stroke allowing surgical techniques and intraoperative management to be modified accordingly. Cervical block anaesthesia significantly reduces the need for internal carotid artery shunting.

Original languageEnglish
Pages (from-to)37-42
Number of pages6
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume13
Issue number1
Publication statusPublished - 1997

Keywords

  • Anaesthetic technique
  • Carotid endarterectomy
  • Perioperative complications

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Surgery

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