Document Detail


Carotid endarterectomy: general anaesthesia with remifentanyl conscious sedation vs loco-regional anaesthesia.
MedLine Citation:
PMID:  20087289     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To retrospectively evaluate and compare the safety and efficacy of general anesthesia with remifentanyl conscious sedation (RCS) vs local-regional anesthesia (LA) for carotid endarterectomy (CEA). METHODS: From January 2004 to January 2008, 390 CEA performed in 325 patients (M/F 214/111, age 75 +/- 7) were collected in 2 groups: RCS group included 275 consecutive CEA in 230 patients carried out under remifentanyl conscious sedation with stopping of the remifentanyl infusion at the carotid clamping time to evaluate the clinical neurological status; LA group was composed of 115 consecutive CEA in 95 patients, performed under local-regional anesthesia. We evaluated complications, postoperative morbidity and mortality, need for shunt insertion and compared the results by means of Student's t-test and chi2 analysis. P value <0.05 (T=2.28) was considered significant. RESULTS: The 30 days mortality was 0.35% in the RCS group and 0% for LA group (P=NS). The 30 days stroke rates were 0.3% and 0% respectively (P=NS). TIA/RIND rates were 0.3% for RCS group and 1.7% for LA group (P=0.47); shunt usage was 20% for RCS group and 17% for LA group (P=0.26). We found higher postoperative nausea/vomiting in the RCS group (3.9% vs 0.8%, P<0.05). CONCLUSIONS: General anesthesia with remifentanyl conscious sedation seems to be a safe technique, allowing monitoring of the neurological status, cerebral protection during arterial clamping, better control of the airway and a good compliance to both the surgeon and the patient. A randomized control trial is needed to prove RCS to be effective as LA.
Authors:
G Marcucci; A Siani; R Antonelli; F Mounayergi; F Accrocca; G A Giordano; R Gabrielli; G Pierettori; A Sbroscia
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  International angiology : a journal of the International Union of Angiology     Volume:  28     ISSN:  0392-9590     ISO Abbreviation:  Int Angiol     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2010-01-20     Completed Date:  2010-10-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8402693     Medline TA:  Int Angiol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  496-9     Citation Subset:  IM    
Affiliation:
Unit of Vascular and Endovascular Surgery, Ospedale San Paolo, Civitavecchia, Rome, Italy. chirurgiavascolarecivitavecchia@aslrmf.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anesthesia, Conduction* / adverse effects,  mortality
Anesthesia, General* / adverse effects,  mortality
Carotid Artery Diseases / mortality,  surgery*
Chi-Square Distribution
Conscious Sedation* / adverse effects,  mortality
Endarterectomy, Carotid* / adverse effects,  mortality
Female
Humans
Hypnotics and Sedatives* / adverse effects
Italy
Male
Monitoring, Intraoperative
Piperidines* / adverse effects
Postoperative Nausea and Vomiting / etiology
Retrospective Studies
Stroke / etiology
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Hypnotics and Sedatives; 0/Piperidines; 132875-61-7/remifentanil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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