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At least 109 records · Page 6Linked to original sources
PubMed2005

A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy.

STUDY OBJECTIVE: To evaluate the relationship between continuous noninvasive monitoring of cerebral saturation (regional cerebral oxygen saturation [rSo2]) and occurrence of clinical and electroencephalographic (EEG) signs of cerebral ischemia during carotid cross-clamping. DESIGN: Prospective clinical study. SETTING: University hospital. PATIENTS: Fifty ASA physical status II and III inpatients undergoing elective carotid endarterectomy with a cervical plexus block. INTERVENTIONS: rSo2 was continuously monitored throughout surgery, while an independent neurologist evaluated the occurrence of both clinical and EEG signs of cerebral ischemia induced during carotid cross-clamping. MEASUREMENTS AND MAIN RESULTS: rSo2 was recorded 1 and 3 minutes after clamping the carotid artery during a 3-minute clamping test. In 5 patients (10%), the carotid clamping test was associated with the occurrence of clinical and EEG signs of cerebral ischemia. All these patients were treated with the placement of a Javid shunt, which completely resolved the symptoms. In no patient was permanent neurological injury reported at hospital discharge. In 4 of these patients, EEG signs of cerebral ischemia were present at both observation times, and in one of them, the duration of cerebral ischemia was less than 2 minutes. The percentage rSo2 reduction from baseline during the carotid clamping test was 17% +/- 4% in patients requiring shunt placement and only 8% +/- 6% in those who did not require it (P = .01). A decrease in rSo2 15% or greater during the carotid clamping test was associated with a 20-fold increase in the odd for developing severe cerebral ischemia (odds ratio, 20; 95% confidence interval, 6.7-59.2) (P = .001); however, this threshold had a 44% sensitivity and 82% specificity, with only 94% negative predictive value. CONCLUSIONS: Continuous rSo2 monitoring is a simple and noninvasive method that correlates with the development of clinical and EEG signs of cerebral ischemia during carotid cross-clamping; however, we could not identify an rSo2 threshold that can be used alone to predict the need for shunt placement because of the low sensitivity and specificity.

Aged↗
PubMed2002

Insertion of vagal nerve stimulator using local and regional anesthesia.

BACKGROUND: Vagal nerve stimulation (VNS) is a valuable therapy for patients with intractable epilepsy. Placement of a vagal nerve stimulator typically requires general anesthesia, which frequently interrupts anticonvulsant therapy. Insertion of the stimulator using regional/local anesthesia may offer the advantages of continuity of anticonvulsant therapy and implantation in the outpatient setting. METHODS: We retrospectively compared the first 10 consecutive patients undergoing VNS implantation under general anesthesia with the first 12 consecutive patients undergoing VNS implantation under regional/local anesthesia. Patients for the regional/local anesthesia were selected on the basis of their ability to cooperate and follow commands. Regional anesthesia for implantation of the VNS leads was achieved by performing superficial and deep cervical plexus blocks. A local anesthetic field block of a small area of the posterior chest provided anesthesia for insertion of the generator. RESULTS: All of the patients undergoing regional/local anesthesia completed the procedure without difficulty and on an outpatient basis. None complained of discomfort, sedation, nausea, or vomiting and none had seizures in the perioperative period. These results contrasted with the group that underwent general anesthesia (n = 10), who had an 80% incidence of nausea and vomiting and a 30% incidence of postoperative seizures. CONCLUSION: VNS implantation under regional/local anesthesia is proficiently performed as an outpatient procedure with minimal postoperative side effects.

Adolescent↗
PubMed2001

[Clonidine combined with flunitrazepam before carotid endarterectomy decreases cerebrovascular CO2 reactivity].

OBJECTIVE: Assess cerebrovascular CO2 reactivity changes using transcranial Doppler sonography (TCD) after oral premedication associating clonidine (2 micrograms.kg-1) and flunitrazepam (70 micrograms.kg-1) in patients scheduled for carotid stenosis surgery. STUDY DESIGN: Prospective study, not randomized, the patient being his own "control". PATIENTS AND METHODS: Thirteen patients undergoing carotid endarterectomy under cervical plexus block were included. The monitoring included: automated arterial pressure cuff, ECG, radial artery catheter, TCD with probe secured in temporal window. The study of the cerebrovascular CO2 reactivity was performed with TCD recording on the side of operation, on the day before, and on the day of carotid endarterectomy, 90 min after the premedication, immediately before surgery. To change PaCO2, four ventilatory states were successively performed: (1) normoventilation, (2) hyperventilation, (3) hypoventilation, (4) "breath-holding test". At each state, it was noted: HR, MAP, PaCO2, mean blood flow velocity in the middle cerebral artery (Vm-MCA), resistance index of Pourcelot (RI), cerebrovascular reactivity (slope Vm-MCA/PaCO2). The results (+/- SEM) were analyzed by Wilcoxon test or t test. RESULTS: After premedication, cerebrovascular CO2 reactivity decreased (0.043 +/- 0.019 vs 0.034 +/- 0.013; p < 0.05) without modification of RI (0.578 +/- 0.291 vs 0.612 +/- 0.025; NS). No complication during carotid clamping was reported. CONCLUSION: Inclusion of clonidine in premedication before carotid stenosis surgery must be questioned because a decrease of cerebrovascular CO2 reactivity could be deleterious in case of intraoperative stroke.

Adrenergic alpha-Agonists↗
PubMed2000

Carotid endarterectomy. A survey of UK anaesthetic practice.

We conducted a postal questionnaire survey of the members of the Vascular Anasthesia Society of Great Britain and Ireland, asking questions about the provision of anasthesia for carotid endartectomy. Of 215 respondents, 187 were currently providing anasthesia for carotid endarterectomy. The majority of respondents (69%) always use general anasthesia for this operation but 99/215 (46%) had some experience of regional anasthesia for carotid endartectomy. Amongst those currently using regional anasthesia, combined deep and superficial cervical plexus block was the technique used by 71%. Other regional techniques used included local infiltration and superficial block alone. During regional anasthesia, most (66%) anasthetists used cerebral monitoring techniques such as stump pressure or transcranial Doppler as well as keeping the patient awake. However, in a significant proportion of cases (37%) under general anasthesia no cerebral monitoring was used. Reported surgical shunt insertion rates were lower in awake (mean 42%) patients than those receiving general anasthesia (61%). Respondents using regional anasthesia were more likely to feel that their technique was appropriate than those using general anasthesia.

Anesthesia↗
PubMed2001

Remifentanil conscious sedation during regional anaesthesia for carotid endarterectomy: rationale and safety.

OBJECTIVES: to prospectively evaluate the safety and efficacy of remifentanil during regional anaesthesia for carotid endarterectomy. METHODS: twenty-eight consecutive patients underwent carotid endarterectomy with combined superficial and deep cervical plexus block supplemented with continuous intravenous 0.04 microg.kg(-1).min(-1)remifentanil infusion. Depth of sedation was monitored using the Observer's Assessment of Alertness/Sedation Scale (OAA/S). The degree of pain, discomfort and anxiety was self-assessed by the patients using a horizontal visual analogue scale. RESULTS: all patients experienced adequate comfort and analgesia. No local anaesthetic supplementation was necessary. No patient had a OAA/S score lower than 4 (with 5=awake/alert to 1=asleep). Respiratory depression did not occur. Selective shunting was required in four cases. No patient was converted to general anaesthesia. There were no permanent neurological deficits, cardiopulmonary complications or deaths. CONCLUSION: remifentanil as a supplement to regional anaesthesia for carotid endarterectomy, provides comfort and analgesia without hampering mental status evaluation.

Aged↗
PubMed1980

Anaesthesia for carotid artery surgery.

Twenty-one carotid endarterectomies were performed on 18 patients anaesthetised during droperidol, fentanyl and a cervical plexus block. This technique permitted testing for motor function during carotid clamping, and allowed the operation to proceed safely without a shunt in the majority of patients.

Anesthesia, Conduction↗
PubMed1989

Comparison of the processed electroencephalogram and awake neurological assessment during carotid endarterectomy.

A processed electroencephalogram (EEG) produced by the Lifescan monitor (Neurometrics), was compared to awake neurological assessment for detecting cerebral ischaemia in seventy patients undergoing carotid endarterectomy under cervical plexus block. Of the six patients demonstrating neurological signs on cross-clamping the carotid, five displayed simultaneous EEG changes, four being detected during surgery, and one being detected after reviewing the EEG postoperatively. Another four patients displayed EEG changes indicative of ischaemia but unassociated with neurological signs. A further patient displayed contralateral intraoperative EEG changes. Hypotension resulted in one EEG change and two cases were associated with technical difficulties with the monitor. The presence of false negatives, possible false positives, technical errors and subjective interpretation associated with the processed EEG make it less reliable than awake neurological assessment for the detection of cerebral ischaemia.

Brain Ischemia↗
PubMed1998

Carotid endarterectomy under regional anesthesia.

Regional anesthesia for carotid endarterectomy is a simple, reliable, and virtually complication-free technique. We began to perform a series of carotid endarterectomy under regional anesthesia at our institution in May 1990. This report describes our experience with 180 operated patients from May 1990 till December 1995, with regional anesthesia. All patients were operated with microsurgery and we utilized the deeply cervical plexus block at the C-4 level associated with superficial block, along the posterior border of the externocleidomastoid muscle. The main advantage of this technique of anesthesia is that it is the only exact method of assessing the need of a shunt by using the neurological status of the awaken patient during trial carotid cross-clamping. The regional anesthesia allows carotid endarterectomy to be safely performed on patients with advanced cardiac disease or severe chronic obstructive pulmonary disease who were not good candidates for general anesthesia. In this 180 patients we performed 198 consecutive endarterectomies (10% bilateral) with a total morbidity-mortality rate of 2.0%.

Anesthesia, Conduction↗
PubMed2004

[Comparison of the influence of general and regional anesthesia on basic haemodynamic parameters during carotid endarterectomy].

Carotid endarterectomy (CEA) is a preventive operation to reduce the incidence of embolic and thrombotic cerebral stroke. CEA carries a significant perioeperartive mortality rate from stroke and myocardial infarction, which may even approach 5%. Thus, anesthetic and surgical techniques are constantly under scrutiny to try to reduce this relatively high incidence of morbidity and mortality. Anesthetic technique for CEA is divided to general (GA) and regional (RA) anesthesia, performed by cervical plexus block. The aim this study was to examine changes of basic haemodynamic parameters, which routinely fallows during CEA in condition of GA and RA. After obtaining institutional approval and informed consent, we randomized 50 patients scheduled for CEA (Tab. 1) in two groups (GA and RA). We fallow blood pressure: systolic (BPs), mean (BPm), diastolic (BPd), heart rate (HR), and RPP index at the examined patients. The examination performed in six control times: before induction of anesthesia (T1), 10 minutes after beginning of operation (T2), 5 minutes after cross clamping of arteria carotis (T3), 5 minutes after declamping arteria carotis (T4), 10 minutes (T5) and 2 hours after operation (T6). The results of study shows significant changes of blood pressure (BPs and BPm) and RPP index in T2 time in patinets undergoing GA. The changes occurred under influence of induction agent thiopental. These changes were in homeostatic range. In RA patinets, no haemodynamic changes registrated in control times. Therefore, from haemodynamic aspect RA was superior to GA.

Aged↗
PubMed1998

[Simultaneously monitoring end tidal CO2 and other parameters versus anesthesia management].

OBJECTIVE: To investigate the significance of end tidal CO2(ETCO2) combined with other techniques in anesthesia management. METHODS: Twenty two patients undergoing general anesthesia were monitored with electromyocardiogram (ECG), invasive arterial blood pressure (IABP), plethysmogram and capnography simultaneously. Ten patients undergoing epidural anesthesia and cervical plexus block were monitored with ETCO2. RESULTS: During general anesthesia the depth of general anesthesia, status of ventilation and the degree of muscle relaxation could be grossly evaluated by simultaneously monitoring ETCO2, capnography, plethysmogram, ECG and IABP. ETCO2 could also provide an objective standard for the assessment of respiratory function during spontaneous ventilation. CONCLUSIONS: ETCO2 combined with other monitoring techniques can increase the safety of anesthesia and the accuracy of anesthesia management.

Anesthesia, Epidural↗
PubMedDate not supplied

[Severe and prolonged EEG depression after induction of general anesthesia for carotid endarterectomy. Report of a clinical case].

A large number of methods are available for intraoperative neurologic monitoring during endarterectomy, although no single method is infallible. Debate over choice of regional or general anesthesia for this surgery persists because of differing conclusions of various studies of risks and benefits. The case of patient undergoing left carotid endarterectomy under general anesthesia is described, in whom after the induction of anesthesia with: midazolam 2 mg, fentanyl 50 g, propofol (fractionate dose of 180 mg) and cisatracurium 12 mg, a total EEG depression occurred persisting for over 10 minutes and was followed by slow recovery, during the awakening of the patient. No significant hemodynamic changes were noted during the induction. No neurologic deficit was observed in the patient after arousal. It is suggested that the probable reason for the EEG response is the particular sensitivity of the patient to some of the induction drugs or to their association. Two weeks later surgery was successfully performed using cervical plexus block, without any anesthetic support. Regional anesthesia allows continuous neurologic assessment of the awaken patient, it is the most sensitive method for detecting inadequate cerebral perfusion and function.

Anesthesia, General↗
PubMed2004

Comparison between local and general anaesthesia for carotid endarterectomy. A retrospective analysis.

AIM: The aim of this study was to compare by a retrospective analysis local anesthesia (LA) versus general anesthesia (GA) for carotid endarterectomy (CEA). METHODS: Two-hundred and 59 patients who underwent CEA, at the Ospedali Riuniti of Reggio Calabria in the period 2000-2001, were enrolled in this study. For analysis purposes, patients were divided into 4 groups, according to their neurological status and to the type of anesthesia. LA was induced either by deep and superficial cervical plexus block (side approach according to Moore). GA was induced with propofol and maintained with sevoflurane. Monitoring of the neurological status was achieved by simple clinical evaluation of the state of consciousness under LA, and by continuous EEG under GA. RESULTS: With LA, a reduction in the duration of intervention and hospital stay, in the number of neurological complications and consequent intraoperative shunts was observed, and admission to the intensive care unit (ICU) was never required. With GA better blood pressure control was achieved, but more intraoperative shunts and admissions to ICU were required, thus increasing overall costs. CONCLUSION: In our experience, LA seems to be the approach of choice for CEA because 1) by preserving the state of consciousness, it allows a simple clinical monitoring of cerebral perfusion maintenance; 2) it reduces the number of intraoperative shunts and the risk of admission to the ICU; 3) it is cost-effective.

Adult↗
PubMed2006

Emergency thyroidectomy in a patient with severe upper airway obstruction caused by goiter: case for regional anesthesia.

A case of severe airway obstruction caused by a giant malignant goiter is presented. The patient had emergency thyroidectomy under regional anesthesia (bilateral superficial cervical plexus block). The procedure was well tolerated and the intraoperative course was uneventful. The anesthetic challenges are discussed and a case is made for regional anesthesia as a safe and reliable anesthetic option for thyroidectomy in this situation.

Aged↗
PubMed1991

[Effectiveness of regional anesthesia for loco-regional carotid surgery. Retrospective review of 147 interventions].

The Authors present a retrospective review that compares general anesthesia with regional anesthesia performed during carotid endarterectomy surgery. The study includes 147 procedures, performed on 144 patients: 76 had general anesthesia and 71 had regional anesthesia. After emphasizing the importance of conscience preservation during regional anesthesia to allow a simple and secure monitoring of the patient's neurologic functions, the Authors point out the decrease of peri- and postoperative accidents, whether neurologic or not, obtained with regional anesthesia. Another essential advantage of this technique is the possibility to insert the transitory shunt only when objectively necessary, ulteriorly reducing neurologic complications. Cervical plexus block is primarily indicated for high risk patients with instable neurologic simptomatology, severe stenosis of the contralateral carotid, coronary heart disease. The technique has proved to be of easy execution, safe and well accepted by the patient and the surgeon.

Aged↗
PubMed1990

[The relations between acupuncture analgesia and changes of concentration of serum metallic ion].

Forty patients treated by thyroidectomy received superficial cervical plexus block or electric acupuncture stimulation of acupoint Hegu and Neiguan bilaterally. All patients were random divided into groups of C, A1, A2 and A3 on the basis of anesthetic method. Every patients were measured their serum concentration of Na+, K+, Ca++, Cu++, Mg++ and Zn++ before and during anesthesia or electric acupuncture stimulation and postoperation. There was no difference about analgesic effect of four groups (P greater than 0.05). Serum Ca++ concentration reduced various level during electric acupuncture stimulation (P less than 0.05-0.01), but no difference between group A1 and group A2 (P greater than 0.05). The results showed: 1. It made level of serum Ca++ reduced because internal environment of patients were affected by the signal of acupuncture. 2. There was no addition effect for the influence of serum Ca++ when electric acupuncture stimulated points Hegu and Neiguan at the same time intravenous injected Pethedine (1.3 mg/kg). 3. It probably disturbed the value of serum Ca++ concentration when intravenous injected 5% Glucose during the operation, but it had not influence on analgesic effect. 4. Acupuncture probably made concentration of serum Na+, Cu++, Mg++ and Zn++ changed which had statistical difference but with marked irregular figure, the real causes are worth going further into research in future.

Acupuncture Analgesia↗
PubMed1988

Thyroid and parathyroid surgery performed with patient under regional anesthesia.

Thyroid and parathyroid surgery is usually performed with the patient under general anesthesia; however, for selected patients regional anesthesia may be preferable. Between September 1977 and March 1986 regional anesthesia was used successfully as the sole anesthetic technique in 17 patients who underwent thyroid surgery and two patients who underwent parathyroid surgery. Procedures included two total thyroidectomies, 14 lobectomies or lobectomies with isthmusectomies, and one isthmusectomy. These 17 operations represent approximately 5% of the thyroid operations performed by the senior surgeon over the corresponding time. One patient underwent combined completion thyroidectomy and parathyroidectomy, and another patient underwent successful parathyroidectomy under regional anesthesia. In two additional patients, procedures could not be completed under regional anesthesia alone. In one of these two patients regional anesthesia appeared to effect a transient recurrent nerve paralysis. The indications for use of regional anesthesia have been primarily patient preference and associated cardiac or pulmonary disease. We now consider as contraindications to regional anesthesia patient apprehension about the technique, deafness, high spinal cord injury, recurrent laryngeal or phrenic nerve palsy, and allergy to local anesthesia. During this period, from 1977 to 1986, our administration of regional anesthesia has evolved from bilateral deep and superficial cervical plexus blocks to bilateral superficial blocks alone using bupivacaine with epinephrine, 1:200,000.

Adult↗
PubMed1997

[Carotid endarterectomy--5-year results in St. Gallen canton hospital].

The 5-year results following carotid endarterectomy at our institution were analysed retrospectively. The aim of this study was to compare our results with those published in the ECST and NASCET studies as a measure of quality control. We studied the outcome of 101 carotid endarterectomies which were performed between 1989 and 1993 in 90 patients. 74 operations were carried out in "symptomatic" and 27 in "asymptomatic" patients. The standard anaesthetic procedure was a cervical plexus block, which was completed in 87% of all operations. The 84 surviving patients on December the 31th 1993 were all followed up with a clinical and directional Doppler examination in our angiologic outpatient clinic during the first half of 1994. The perioperative stroke rate was 1.98% for the whole group and 2.7% for the "symptomatic" group. The cumulative stroke rate for a period of three years (measured by the Kapplan-Meier method) amounted to 3% (1% per year); the cumulative stroke rate for the "symptomatic" group was 4% in a two year period (2% per year). The results and outcome of carotid endarterectomy at our institution are comparable to the ECST and NASCET studies regarding perioperative mortality, perioperative stroke rate and rate of ipsilateral stroke during the first 2 years after operation.

Aged↗