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Objective: To evaluate the efficacy and security of the cervical plexus block and the continuous cervical peridural anaesthesia in carotid surgery, using ropivacaine as local anaesthetic., Methods: 90 patients (ASA II-III, age 67-84) who had signed informed consent were randomised in two groups. In Group C continuous cervical plexus block was performed using ropivacaine 0,75% 2,5 mg/kg. In Group P continuous cervical peridural anaesthesia was performed, at level C6-C7 or C7-T1, introducing the catheter for 5 cm into the epidural space and injecting in 20 min ropicavacine 0,5% 0,9 mg/kg together with 50-100 g of fentanyl. ECG, HR, arterial blood pressure, neurological status of conscious patient and eventual complications were all monitored., Results: Demographical data, duration of surgery and level of anaesthesia were all uniform in both groups. At the onset of the block the values of the systolic arterial blood pressure were significantly lower in Group P compared to Group C. One case of intradural injection of ropivacaine was reported and one case of intravascular injection, without remaining deficits. There were no perioperative complications., Conclusions: cervical plexus block and continuous cervical peridural anaesthesia performed with ropivacaine are both effective for anaesthesia in carotid surgery. Ropivacaine, for its minor cardiotoxicity, yields eventual complications related to the two methods, less severe. more...

Carotid surgery must be preventive; therefore cerebral protection procedures have been the centre of interest for a decade. Nowadays local cervical block anaesthesia seems to have changed the terms of the problem allowing achieve the aim of "no risk surgery". Therefore we considered our 16 year experience (352 carotids operated on 290 patients). Since 1990 we employed cervical block anaesthesia. In order to ratify as much as possible the two groups of comparison, considering that we adopted some exclusion criteria, we compared the results of the first hundred carotids that underwent surgery with general anaesthesia and the first hundred operated using cervical block anaesthesia. Since we adopted cervical block anaesthesia there was no need of intra-operative monitoring systems because we considered exclusively the patients' clinical answer to preclamping. The use of shunt decreased from 9% to 3%. Surgery performed in cervical block anaesthesia gives a positive impression. This is due to the fact that there is not only a significant reduction of the morbidity rate, especially from a neurologic point of view, but also a reduction of the post-operation hospital stay. Furthermore there is also a better organization of the surgical phases. Direct monitoring of the cerebral function allows a precise analysis of the peri-operatory neurological events. In conclusion our study suggests that cervical block anaesthesia allows clinical benefits for the patient as far as safety is concerned being also more convenient under the economic point of view. more...

Superficial cervical plexus block in association with laryngeal mask for the airways control has improved the postoperative outcome, in comparison with a previous group in general anaesthesia, performed by the same equipment. The local anaesthetic infiltration as a preemptive analgesia give us good evidences in pain control. The laryngeal mask contributes to a good surgical field and avoid the neck hypertension. more...

The purpose of carotid surgery is to prevent the incidence of stroke in patients with cerebrovascular disease. It's important, therefore, to find the most useful methods of cerebral protection and flow monitorization during carotid endarterectomy. It is well known that patient's clamping tolerance changes according to his anatomical and physiopathological conditions (contralateral carotid patency, stenosis, occlusion), and compensative circles efficiency (Willis). General anaesthesia reduces cerebral metabolic requests and allows a better pressure control, but requires difficult, expensive and complex monitoring techniques. On the contrary loco-regional anaesthesia alone can't assure cerebral protection, but allows to test in real-time patient's reaction at clamping. If an ischaemia occurs, carotid shunting allows to perform endarterectomy, but this method might produce any complication: distal plaque dissection, embolizations. Authors show their 10 years (1986-1996) experience of 624 carotid endarterectomies performed on 580 patients evaluated by: -symptomatic or asymptomatic lesions -mono-bilateral stenosis -general or loco-regional anaesthesia -clamping tolerance -carotid shunting -intra-postoperative complications (temporary or persistent). According to results, authors propose loco-regional anaesthesia in carotid endarterectomy as a simply available and at low costs method to monitorize cerebral functions. In addition it has low rate complications, few contra-indications and may be selected like first-choice anaesthesiological method. more...

Syndromes caused by the compression of the neurovascular bundle are not a rare pathology, though their exact frequency cannot be assessed. Neurovascular bundle in the upper limbs may be compressed at the costo-clavicular space, interscalene triangle or at the insertion of the minor pectoralis muscle into the coracoid process. More than 90% of patients present neurological symptoms and 10% also have vascular problems. Diagnosis depends on a careful clinical and instrumental study of the patients. Arteriography, phlebography and Doppler tests were of value in the diagnostic approach, showing the compression of the subclavian artery and vein using the arm abduction manoeuvre. Electromyography is of value in differential diagnosis of the carpal tunnel syndrome showing the entity and site of nerve compression. The best form of surgical treatment is resection of the first rib according to Roos, using an extrapleural and transaxillary route. more...

The main anesthesiological problem in TEAC operations is the possibility of evaluating the degree of tolerance after carotid artery clamping. When facing this situation, some anesthesiologists prefer to administer general anesthesia, others prefer loco-regional anesthesia. On the basis of their background and experience, the Authors, from 1.1.1987 to 12.31.1988, have performed 142 nerve blocks of the superficial and the cervical plexus. The proposed technique is simple. No side effects are observed. Moreover it is gratifying for the surgeon and safe from risks for patients. Loco-regional anesthesia permits a close neurologic monitoring that is easily understandable and inexpensive. When performing this kind of surgery, this technique seems to be valid and effective. more...