Document Detail

The differing effects of regional and general anaesthesia on cerebral metabolism during carotid endarterectomy.
MedLine Citation:
PMID:  8760979     Owner:  NLM     Status:  MEDLINE    
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.
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    
Department of Vascular Surgery, General Infirmary, Leeds, U.K.
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MeSH Terms
Anesthesia, General*
Anesthetics, Inhalation
Anesthetics, Local
Brain / metabolism*
Brain Chemistry
Electron Transport Complex IV / analysis
Endarterectomy, Carotid*
Hemoglobins / analysis
Monitoring, Intraoperative
Nerve Block*
Nitrous Oxide
Oximetry / methods
Oxygen / blood
Oxyhemoglobins / analysis
Prospective Studies
Spectrophotometry, Infrared / methods
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 Transport Complex IV

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

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