ANESTHETIC METHODS IN REOPERATIVE CAROTID SURGERY

It has been suggested that general anesthesia is the preferred method for reoperative carotid surgery for several reasons, including: the di fficulty of the reoperative dissection; the disease may extend unusual ly high into the internal carotid artery; and the reconstruction requi red may be more complex than a typical endarterectomy. The purpose of this study is to show that reoperative carotid surgery can be performe d safely under regional anesthesia. The records of 109 reoperative car otid operations performed on 96 patients over the past 25 years were r eviewed. Procedures performed under regional anesthesia were compared to those performed under general anesthesia with respect to patient ch aracteristics, intraoperative courses, and perioperative results. Regi onal anesthesia was utilized in 79 operations (72.5%); 30 operations w ere performed with general anesthesia (27.5%). The two patient groups were essentially equivalent with regard to atherosclerotic risk factor s, preoperative neurologic symptoms, and the prevalence of contralater al total occlusion. The etiologies for recurrent disease included recu rrent atherosclerosis (50.4%), intimal hyperplasia (30.3%), and vein p atch aneurysm (9.2%). The methods of reconstruction employed included saphenous vein patch (47.7%), vein interposition graft (11.9%), prosth etic patch (20.2%), and prosthetic graft (20.2%). Perioperative stroke s occurred in one case performed under regional anesthesia (1.3%), and in two cases under general anesthesia (6.6%); this difference was not statistically significant. Reoperative carotid artery surgery can be performed under regional anesthesia safely in the majority of instance s. The aforementioned theoretical factors in favor of general anesthes ia could also lead to technical difficulties with intraarterial shunt insertion. Having the patient awake, even if just long enough to prove that the patient will tolerate carotid artery clamping, might simplif y many of these operations by avoiding shunt insertion. Regional anest hesia should therefore be considered an acceptable option in cases of reoperative carotid surgery.