ANESTHESIA FOR CAROTID ENDARTERECTOMY - A SURVEY

Indications fur carotid endarterectomy (CEA) have been expanded recent ly, and a consensus statement has been made regarding these changes. H owever, the debate regarding the ''ideal'' anesthetic for CEA remains on-going. This study was designed to evaluate the actual anesthetic te chniques used by anesthesiologists for CEA. A total of 426 I-page ques tionnaires were mailed to all current (1995) members of the Society of Neurosurgical Anesthesia and Critical Care (SNACC). Oi these, 216 (50 .7%) were completed and returned. The majority of these respondents (8 4.7%) administered general anesthesia (GA) for CEA. Regional anesthesi a (RA) was the anesthetic method of choice for 16.7%, whereas 2.8% eac h chose either local anesthesia (LOG) or a combined regional/general ( RA/GA) technique. Despite the controversial role of nitrous oxide in n euroanesthesia, 74.6% of those returning the survey use nitrous oxide during CEA. Intraoperative neuromonitoring use was reported by 90% of the respondents, with the electroencephalography (EEG) the favored mod ality (67.5%). Specific intraoperative neuroprotective measures were p rovided by only 22.2% of all respondents, with barbiturates as the fav orite method (50.0%). The technique of intraoperative hypertension is practiced by a majority of those surveyed (61.1%), with the most commo n target blood pressures being either preoperative baseline or preoper ative baseline plus 20%. Although there is some trend towards noninten sive care setting for postoperative care, the intensive care remains t he location of choice for overnight care of CEA patients (71.8%). The results of this study show that despite arguments for RA over GA, the majority of anesthesiologists surveyed choose GA for CEA.