CAROTID ENDARTERECTOMY SURGERY AND ICU ADMISSIONS - A REGIONAL ANESTHESIA PERSPECTIVE

Stroke is a major cause of mortality and morbidity in the United State s. This study was performed to determine whether the authors' practice of monitoring the majority of patients in the postanesthesia care uni t for 2 hours, selectively admitting the recovering carotid endarterec tomy patients to the intensive care unit when feasible, and using regi onal anesthesia for the majority of cases, resulted in adverse outcome s or compromised the safety of the operation at a tertiary care academ ic medical center. The records of 337 patients (a total of 420 procedu res) who underwent carotid endatertectomy surgery without concurrent h eart surgery during a consecutive 18-month period ending in June, 1995 were reviewed. Regional anesthesia was the technique used in 97% of t he procedures. Shunt placement was deemed necessary in 7% of the proce dures. Postoperative strokes occurred in approximately 1% of patients. No shunted patients had a postoperative stroke. The rate of admission to intensive care units was 4%. Blood pressure control accounted for 73% of the patients admitted to intensive care units. Most patients re quired 2 hours of monitoring in the postanesthesia care unit before tr iage to the appropriate level of postoperative care. These results sug gest that a monitoring period of 2 hours in the postanesthesia care un it allows for safe assessment of the postoperative carotid endarterect omy patient, and that routine intensive care unit admission after caro tid endarterectomy surgery is not necessary.