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One-year experience in carotid endarterectomy combining general anaesthesia with preserved consciousness and sequential carotid cross-clamping
- Source :
- Acta bio-medica : Atenei Parmensis
- Publication Year :
- 2018
-
Abstract
- Background and aim of the work: We report 1-year single-centre experience in carotid endarterectomy (CEA) combining general anaesthesia with preserved consciousness (GAPC) and standardized carotid sequential cross-clamping, for our protocol effectiveness evaluation in reduction of perioperative stroke, death or cardiologic complications. Methods: We considered all patients who underwent CEA in 2016. All patients underwent superficial cervical plexus block and GAPC with Remifentanil. The surgical technique consisted of common carotid artery (CCA) cross-clamping, carotid bifurcation isolation, external (ECA) and internal carotid artery (ICA) cross-clamping. After CCA cross-clamping, we performed a neurological tolerance test (NTT); this allowed selective shunting only for positive NTT. Primary end-points were: transient ischemic attack (TIA)/stroke, myocardial infarction, death in perioperative period. Secondary end-points were: carotid shunting, peripheral cranial nerves injuries (PCNI), GAPC intolerance, other complications, reintervention in perioperative period, length of hospital stay. Results: 104 consecutive patients underwent CEA with this protocol in the considered period. Twenty-seven (25.9%) patients were symptomatic. Mean clamping time was 48±13.5 minutes. Five cases (4.8%) requested internal carotid artery shunting. No TIA/stroke, myocardial infarction or death were recorded in the perioperative period. PCNI were observed in 19 cases (18.2%) in the immediate post-operative period; 16 of them (84.2%) showed complete or partial resolution at discharge. Only one patient (0.9%) showed GAPC intolerance. No other complication occurred. Three patients (2.9%) underwent reintervention for neck haematoma drainage. Mean hospital stay were 3±0.9 days. Conclusions: GAPC associated with sequential carotid cross-clamping appeared to be safe and effective in prevention of major neurological and cardiologic complications during CEA. (www.actabiomedica.it).
- Subjects :
- Local anaesthesia
Male
Endarterectomy, Carotid
Cervical Plexus Block
Carotid Stenosi
Anesthesia, General
General anaesthesia
preserved consciousness
Remifentanil
Analgesics, Opioid
Stroke
Postoperative Complications
Carotid endarterectomy
carotid stenosis
Humans
Original Article
Female
cardiovascular diseases
Preserved consciousne
Postoperative Complication
Aged
Human
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- Acta bio-medica : Atenei Parmensis
- Accession number :
- edsair.pmid.dedup....ff44c84605fd89369266b4c72c237cff