LOCAL-ANESTHESIA AND PROPOFOL-FENTANYL SEDATION FOR CAROTID-ARTERY SURGERY

Background: In patients undergoing carotid artery surgery with local a naesthesia (LA), a sedative/analgesic pharmacological supplement is ap propriate in most cases in order to provide comfort. This adjunct shou ld not preclude continuous clinical neurological monitoring. The aim w as to investigate if a combination of fentanyl and propofol to supplem ent LA would provide comfort for the patient, allow continuous clinica l neurological monitoring and absence of difficulties for the anaesthe tist, and good conditions for surgery, including insertion of a shunt if this should become necessary. Methods: During a 1-year period low d oses of propofol and fentanyl were used to supplement LA in 36 cases o f carotid artery surgery in 34 consecutive patients. A shunt tvas only used if neurological dysfunction occurred. Data on haemodynamics, pul monary gas exchange, clinical neurological monitoring and subjective o pinions from patients, surgeons and anaesthetists were obtained. Morbi dity within 30 days was documented. Results: Conversion to general ana esthesia was undertaken in one patient;previously operated on the same artery, who became unconscious due to a stroke during manipulation of the artery before arteriotomy. No other adverse outcome was found wit hin 30 days. In the remaining 35 cases the procedures were carried out under LA. Stump pressures below 50 mmHg were found in 17/35 cases. In traoperative neurological dysfunction was detected in 10/35 cases (stu mp pressures between 23 and 60 mmHg). Shunting was easily performed, a nd rapidly relieved the neurologic symptoms in all these patients. Int raoperative respiratory and haemodynamic control was satisfactory. Eas e of performance, including clinical neurological monitoring, was ackn owledged by both anaesthetists and surgeons, and all 33 patients (35 o perations) who were accessible for a postoperative interview stated th at they would prefer the same regimen in the case of further surgery. Conclusion: The number of cases in this open uncontrolled study does n ot permit an evaluation of this anaesthetic and sedative technique in terms of neurological and cardiac outcome. Thus, we simply want to inf orm about our positive experiences regarding patient acceptance and ea se of performance in all relevant respects when fentanyl and propofol are used to supplement LA for carotid artery surgery.