Document Detail


The differing effects of regional and general anaesthesia on cerebral metabolism during carotid endarterectomy.
MedLine Citation:
PMID:  8760979     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To examine the effects of either regional (RA) or general (GA) anaesthesia upon parameters of cerebral metabolism (near infrared spectroscopy, continuous jugular venous oximetry) during carotid endarterectomy. DESIGN: Prospective, non-randomised, observational study. MATERIALS: Sixty-five consecutive patients (33 RA; 32 GA) undergoing carotid endarterectomy. METHODS: (i) Near infrared spectroscopy: measurement of concentrations of cerebral oxyhaemoglobin (HbO2), deoxyhaemoglobin (HHb) and oxidised cytochrome oxidase (caa3). (ii) Continuous jugular venous oximetry: O2 saturation of jugular venous blood (SJvO2). (iii) Stump pressure in internal carotid artery. RESULTS: A reduction in SJvO2 (RA: 13% (95% CI-3 to 29%) GA: 9% (95% CI-2 to 20%), p < 0.08) and a fall in caa3 levels (RA vs. GA: 25/31 vs. 19/31, p = 0.2) was more likely in patients given a RA following application of the carotid clamps. When HbO2 and caa3 did fall however spontaneous recovery occurred more often (RA vs. GA; caa3: 18/25 vs. 5/19, p < 0.005; HbO2: 30/31 vs. 4/28, p < 0.001). CONCLUSIONS: Although GA may offer a degree of cerebral protection by reducing cerebral metabolic rate (lower falls in SJvO2 and caa3) RA preserved cerebral autoregulation as judged by the spontaneous recovery in caa3 and HbO2 levels.
Authors:
A J McCleary; N M Dearden; D H Dickson; A Watson; M J Gough
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery     Volume:  12     ISSN:  1078-5884     ISO Abbreviation:  Eur J Vasc Endovasc Surg     Publication Date:  1996 Aug 
Date Detail:
Created Date:  1996-10-16     Completed Date:  1996-10-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9512728     Medline TA:  Eur J Vasc Endovasc Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  173-81     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery, General Infirmary, Leeds, U.K.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anesthesia, General*
Anesthetics, Inhalation
Anesthetics, Local
Brain / metabolism*
Brain Chemistry
Bupivacaine
Electron Transport Complex IV / analysis
Endarterectomy, Carotid*
Female
Hemoglobins / analysis
Humans
Isoflurane
Male
Monitoring, Intraoperative
Nerve Block*
Nitrous Oxide
Oximetry / methods
Oxygen / blood
Oxyhemoglobins / analysis
Prilocaine
Prospective Studies
Spectrophotometry, Infrared / methods
Chemical
Reg. No./Substance:
0/Anesthetics, Inhalation; 0/Anesthetics, Local; 0/Hemoglobins; 0/Oxyhemoglobins; 10024-97-2/Nitrous Oxide; 2180-92-9/Bupivacaine; 26675-46-7/Isoflurane; 721-50-6/Prilocaine; 7782-44-7/Oxygen; 9008-02-0/deoxyhemoglobin; EC 1.9.3.1/Electron Transport Complex IV

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


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