A COMPARISON OF REGIONAL AND GENERAL-ANESTHESIA IN PATIENTS UNDERGOING CAROTID ENDARTERECTOMY

Purpose: The optimal anesthetic for use during carotid endarterectomy is controversial. Advocates of regional anesthesia suggest that it may reduce the incidence of perioperative complications in addition to de creasing operative time and hospital costs. To determine whether the a nesthetic method correlated with the outcome of the operation, a retro spective review of 3975 carotid operations performed over a 32-year pe riod was performed. Methods: The records of all patients who underwent carotid endarterectomy at our institution from 1962 to 1994 were retr ospectively reviewed. Operations performed with the patient under regi onal anesthesia were compared with those performed with the patient un der general anesthesia with respect to preoperative risk factors and p erioperative complications. Results: Regional anesthesia was used in 3 382 operations (85.1%). There were no significant differences in the a ge, gender ratio, or the rates of concomitant medical illnesses betwee n the two patient populations. The frequency of perioperative stroke i n the series was 2.2%; that of myocardial infarction, 1.7%; and that o f perioperative death, 1.5%. There were no statistically significant d ifferences in the frequency of perioperative stroke, myocardial infarc tion, or death on the basis of anesthetic technique. A trend toward hi gher frequencies of perioperative stroke (3.2% vs 2.0%) and perioperat ive death (2.0% vs 1.4%) in the general anesthesia group was noted. In examining operative indications, however, there was a significant inc rease in the percentage of patients receiving general anesthesia who h ad sustained preoperative strokes when compared with the regional anes thesia patients (36.1% vs 26.4%; P <0.01). There was also a statistica lly significant higher frequency of contralateral total occlusion in t he general anesthesia group (21.8% vs 15.4%; P=0.001). The trend towar d increased perioperative strokes in the general anesthesia group may be explicable either by the above differences in the patient populatio ns or by actual differences based on anesthetic technique that favor r egional anesthesia. Conclusions: In a retrospective review of a large series of carotid operations, regional anesthesia was shown to be appl icable to the vast majority of patients with good clinical outcome. Al though the advantages over general anesthesia are perhaps small, the v ersatility and safety of the technique is sufficient reason for vascul ar surgeons to include it in their armamentarium of surgical skills. C onsidering that carotid endarterectomy is a procedure in which complic ation rates are exceedingly low, a rigidly controlled, prospective ran domized trial may be required to accurately these differences.