Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal

Mercês Lobo; Joana Mourão; Graça Afonso

doi:10.1016/j.bjane.2014.03.011

Scientific Article

Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal

Endarterectomia carotídea: revisão de 10 anos de prática de anestesia geral e locorregional num hospital terciário em Portugal

Mercês Lobo; Joana Mourão; Graça Afonso

http://dx.doi.org/10.1016/j.bjane.2014.03.011 Braz J Anesthesiol, vol.65, n4, p.249-254, 2015

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Abstract

BACKGROUND:: Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results.

OBJECTIVES:: Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality) in a tertiary center in Portugal and review the literature.

METHODS:: Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation.

RESULTS:: A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregional anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding per operative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference.

CONCLUSIONS:: We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers.

Keywords

Carotid endarterectomy, General and locoregional anesthesia, Anesthesia for vascular surgery, Review

Resumo

JUSTIFICATIVA:: Estudos retrospectivos e prospectivos randomizados têm comparado a anestesia locorregional e geral para endarterectomia carotídea, mas sem resultados definitivos.

OBJETIVOS:: Avaliar a incidência de complicações (médicas, cirúrgicas, neurológicas e mortalidade intra-hospitalar) num centro terciário em Portugal e revisão da literatura.

MÉTODO:: Análise retrospectiva dos doentes submetidos a endarterectomia entre 2000 e 2011 com o software consulta hospitalar.

RESULTADOS:: Foram identificados 750 doentes, mas em 13 foi necessário converter a anestesia locorregional em anestesia geral. Dos 737 doentes incluídos nesta análise, 74% foram submetidos a anestesia locorregional e 26% a anestesia geral. Não foram encontradas diferenças estatisticamente significativas relativamente às variáveis estudadas no perioperatório entre os dois grupos. O uso de shunt foi mais frequente em doentes submetidos a anestesia geral, diferença estatisticamente significativa. A diferença entre grupos de acidentes vasculares cerebrais e mortalidade não foi estatisticamente significativa. O tempo médio de internamento foi mais curto nos doentes submetidos a anestesia locorregional, diferença estatisticamente significativa.

CONCLUSÕES:: Verificamos que os dados encontrados são sobreponíveis aos descritos na literatura. Após revisão da literatura constatamos que o número de estudos que comparam anestesia locorregional e anestesia geral e o seu impacto no delirium, nas alterações cognitivas e na diminuição da qualidade de vida no pós-operatório é ainda diminuto e pode fornecer dados importantes para a comparação das duas técnicas. Assim, permanecem algumas questões em aberto que obrigam à feitura de estudos randomizados com maior número de doentes e em novas áreas.

Palavras-chave

Endarterectomia carotídea, Anestesia geral e locorregional, Anestesia para cirurgia vascular, Revisão

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Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal

Endarterectomia carotídea: revisão de 10 anos de prática de anestesia geral e locorregional num hospital terciário em Portugal

Mercês Lobo; Joana Mourão; Graça Afonso

Abstract

Keywords

Resumo

Palavras-chave

References

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