Carotid endarterectomy and local anaesthesia: reducing the disasters

Purpose: The study was designed to assess one surgeon's operative mortality and morbidity for carotid endarterectomy using local anaesthetic (LA) comp ared to general anaesthetic (GA) techniques. Method: Data were collected prospectively from 200 patients undergoing LA c arotid surgery compared with 243 patients undergoing carotid surgery using GA technique. Indication for surgical, pathology, postoperative morbidity a nd mortality was assessed. Results: No major strokes or deaths occurred in the LA group (0/200), Signi ficantly more major strokes and/or deaths occurred in the GA group (11/243, 4.5%; P = 0.016), Significant less shunt usage was associated with LA (LA 18/200, 9% versus 94/243, 39%; P = 0.001), The absense of a shunt was assoc iated with more major events in the GA group (5/143, P = 0.001, Age greater than 74 yr was associated with greater major events (4/31, P = 0.002). No significant difference in the frequency of cardiovascular complications was observed (LA, 15/200 (7.5%) vs GA, 19/243(7.8%); P = 0.924). Conclusion: Local anaesthesia enables the surgeon to assess the level of ce rebral perfusion with an awake patient, gives greater assurances of cerebra l protection during arterial clamping and a provides for a more relaxed and cautious endarterectomy and repair, This study demonstrates reduction in m ortality and major stroke events in patients operated on with these conditi ons, (C) 2000 The International Society for Cardiovascular Surgery. Publish ed by Elsevier Science Ltd. All rights reserved.