Regional/local anesthesia: a safe and reasonable choice for patients undergoing carotid endarterectomy

TLDR: Carotid endarterectomy can be performed with an acceptable neurologic complication rate under either type of anesthesia, and use of regional anesthesia decreases intraoperative shunting and may decrease the rate of cardiopulmonary complications.

Abstract: Purpose The study compares the outcome of carotid endarterectomy in the community hospital setting using regional versus general anesthesia. Methods Two hundred thirty-six consecutive operations performed on 200 patients (99 operations using superficial and deep cervical block with local supplementation, and 137 procedures using general anesthesia) during a three-year period were analyzed retrospectively. Noncontinuous data were analyzed using Pearson chi-square, continuous data using Student's t-test. Results Demographic data and risk factors were similar for both groups. However, patients in the regional anesthesia group had a higher incidence of contralateral stroke and a lower incidence of peripheral vascular disease than patients in the general anesthesia group. Shunts were used less frequently for the regional anesthesia group. The neurologic complication rate was 2.2% for the general anesthesia group and 2.0% for the regional anesthesia group. The single death (fatal stroke) occurred in the general anesthesia group. Four of five major cardiopulmonary complications occurred in the general anesthesia group. Conclusions Carotid endarterectomy can be performed with an acceptable neurologic complication rate under either type of anesthesia. Use of regional anesthesia decreases intraoperative shunting and may decrease the rate of cardiopulmonary complications.