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J P Derosier

Publications and source records attributed to J P Derosier.

6 recordsLinked to original sources
PubMed1997

Risk of early controlateral carotid endarterectomy.

Between January 1984 and January 1994, we performed early endarterectomy of the controlateral carotid on 94 patients within a delay of 1 to 8 days after the first endarterectomy. Lesions were symptomatic in 58 patients (62%) and asymptomatic in 36 patients (38%). Eighty-four operations were performed under cervical block anesthesia (89%), eight under general anesthesia, and two under local anesthesia (2%). Severe intraoperative hypertension occurred in seven patients (7%) including five under cervical block anesthesia (6%) and two under general anesthesia (25%). Two patients (2.1%) died of stroke secondary to carotid thrombosis in one case and hyperperfusion syndrome in one case. Morbidity included one transient ischemic attack (1%) and one myocardial infarction (1%). Postoperative control of patency revealed asymptomatic occlusion of the internal carotid artery in two patients, accounting for one of the two deaths. Our findings demonstrate that neurologic mortality/morbidity is not higher after early controlateral carotid endarterectomy than unilateral endarterectomy.

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PubMed1990

Cervical epidural anaesthesia for carotid artery surgery.

A series of 394 patients (251 men, 143 women; mean age 70.0 +/- 8.4 yr) selected for carotid artery surgery (CAS) performed under cervical epidural anaesthesia (CEA) was analysed retrospectively. Carotid endarterectomy was performed in 326 patients and saphenous vein bypass in 68. The cervical epidural administration of 15 ml 0.5 per cent bupivacaine or 0.37-0.40 per cent bupivacaine plus fentanyl (50-100 micrograms) resulted in an effective sensory blockade from C2 to T4-T8. Patients were maintained awake during the surgical procedure in comfortable condition. Serious complications included dural puncture in two patients, epidural venipuncture in six patients and respiratory muscle paralysis in three patients. Hypotension (10.9 per cent) and bradycardia (2.8 per cent) were the most frequent side-effects of CEA. Transient neurological events were noticed in 84 patients during the surgical procedure. A definite neurological deficit occurred postoperatively in 12 patients. Three patients suffered postoperative myocardial infarction. The mortality rate was 2.3 per cent (nine patients). Carotid artery surgery may be performed under CEA but haemodynamic variables should be monitored closely and managed closely during the procedure.

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PubMed1989

[Cervical epidural anesthesia in carotid artery surgery].

A series of 394 patients who underwent surgery of the carotid artery under cervical extradural anaesthesia is presented. With this technique the patient remains conscious throughout the operation, which facilitates neurological monitoring. Due to failure or complication, extradural anaesthesia was abandoned and replaced by general anaesthesia in 1.5 per cent of the cases. The mortality rate in this series was 2.3 per cent; in 2 out of 3 cases death was of neurological origin; 21 per cent of the patients had peroperative neurological accidents which, in 9 out of 10 cases, were due to a low cerebral blood flow rate during clamping. Thirty-five intra-arterial shunts (8.9 per cent) were installed, and none of these accidents was permanent. Twenty-five patients (6.3 per cent) had postoperative deficit which did not regress in 12 cases (3 per cent). The risk of peroperative neurological accident was significantly increased in patients with bilateral lesions of the vertebral arteries (x 3.5) or with occlusion of the contralateral carotid artery (x 4.5). Surgery of the carotid artery in conscious patients reveals a high incidence of ischaemic neurological events the reversibility of which is ensured by appropriate therapeutic procedures (arterial shunt, increase of brain perfusion pressure). Patients at risk of neurological accidents may benefit from cervical extradural anaesthesia.

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