The influence of anesthetic technique on perioperative complications after carotid endarterectomy☆,☆☆,★
Section snippets
PATIENTS AND METHODS
The vascular registry at Washington University School of Medicine retrospectively reviewed the records of 584 consecutive patients undergoing 679 carotid endarterectomies during the last 6 years (April 1987 to March 1993) on the vascular surgery service at Barnes Hospital in St. Louis, Mo. Patients treated with combined carotid and coronary artery revascularization were excluded. Postoperative follow-up information was obtained through office visit records, letters to referral physicians, and
DEFINITIONS AND STATISTICAL ANALYSIS
The two anesthetic techniques were compared to identify differences in operative time, hospital stay, and perioperative complications and deaths with use of all the procedures (n = 679) performed in each anesthetic group. Perioperative morbidity was divided into neurologic and nonneurologic complications that occurred within 30 days of surgery. Neurologic complications were subdivided into temporary (transient ischemic attack, amaurosis fujax, seizure) or permanent (stroke, retinal infarction)
Perioperative morbidity and mortality
Perioperative neurologic events occurred after 35 (5.15%) operations (Table II). Nineteen (2.8%) were temporary neurologic deficits or perioperative seizures, and 16 were strokes for a perioperative stroke rate of 2.4%. Ten (2.8%) of the operations performed with the patient receiving general anesthetic were complicated by stroke, whereas six (1.9%) carotid endarterectomies performed with the patients receiving cervical block anesthetic were associated with stroke (p = 0.79). Operations for
DISCUSSION
The success and safety of carotid endarterectomy is impressive, with several multicenter prospective and retrospective studies reporting operative stroke-death rates of 3% to 6%. 1, 2, 9 The technical aspects of carotid endarterectomy are well established, and it appears unlikely that additional modifications in the existing surgical technique will lead to substantial improvements in operative morbidity and mortality rates. This report shifts the emphasis from surgical to anesthetic technique
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Cited by (0)
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From the Section of Vascular Surgery, Department of Surgery, and Department of Anesthesia (Dr. Young-Beyer), Washington University School of Medicine, St. Louis.
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Reprint requests: Brent T. Allen, MD, One Barnes Plaza, Suite 5103 QT, St. Louis, MO 63110.
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