Document Detail

Comparison of renin and catecholamine release in patients undergoing eversion or conventional carotid endarterectomy.
MedLine Citation:
PMID:  22551910     Owner:  NLM     Status:  Publisher    
OBJECTIVE: The two techniques for carotid endarterectomy (CEA)-conventional (C-CEA) and eversion (E-CEA)-have different effects on blood pressure. This study compared sympathetic activity after C-CEA and E-CEA, as measured by renin and catecholamine levels. METHODS: E-CEA (n = 40) and C-CEA (n = 34) were performed in 74 patients with high-grade carotid stenosis. The choice of technique was made at the discretion of the operating surgeon. All patients received clonidine (150 μg) preoperatively. Regional anesthesia was used. The carotid sinus nerve was transected during E-CEA and preserved during C-CEA. Renin, metanephrine, and normetanephrine levels were measured preoperatively and at 24 and 48 hours postoperatively. RESULTS: Compared with baseline, levels of renin, metanephrine, and normetanephrine decreased at 24 and 48 hours after C-CEA (P < .0001). After E-CEA, however, renin and normetanephrine levels were unchanged at 24 hours, and metanephrine levels were increased (P < .0001). At 48 hours, levels of renin (P = .04), metanephrine (P < .0001), and normetanephrine (P = .02) were increased. Compared with C-CEA, E-CEA was associated with significantly increased sympathetic activity at 24 and 48 hours (P < .0001). Although the use of vasodilators for postoperative hypertension did not differ in the postanesthesia care unit (E-CEA 35% vs C-CEA 18%, P = .12), vasodilator use on the ward was more frequent after E-CEA (60% vs 32%, P = .02). CONCLUSIONS: E-CEA appears to be associated with greater postoperative sympathetic activity and vasodilator requirements than C-CEA, findings likely related to sacrifice of the carotid sinus nerve during E-CEA but not C-CEA.
Serdar Demirel; Laura Macek; Nicolas Attigah; Hans Bruijnen; Maani Hakimi; Thomas Able; Dittmar Böckler
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-30
Journal Detail:
Title:  Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter     Volume:  -     ISSN:  1097-6809     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-5-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Department of Vascular and Endovascular Surgery, Ruprecht-Karls University, Heidelberg, Germany.
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