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BJA Advance Access originally published online on July 9, 2007
British Journal of Anaesthesia 2007 99(3):415-420; doi:10.1093/bja/aem171
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Regional anaesthesia for carotid endarterectomy: an audit over 10 years

M. Hakl1,*, P. Michalek2,3, P. Sevcík1, J. Pavlíková1 and M. Stern2

1 Department of Anaesthesiology and Intensive Care, St Anns Teaching Hospital in Brno, Pekarská 53, 656 91 Brno, The Czech Republic
2 Department of Anaesthesia and Intensive Care, Na Homolce Hospital, Roentgenova 2, 150 30 Prague, The Czech Republic
3 Department of Anaesthetics, Antrim Area Hospital, 45 Bush Road, Antrim, BT41 2RL, UK

* Corresponding author. E-mail: marek.hakl{at}fnusa.cz

Background: The aim of this retrospective study was to compare the failure rates and the frequency of anaesthesia-related complications of two different methods of regional anaesthesia used for carotid endarterectomy—cervical epidural (CE) anaesthesia and cervical plexus block (CPB).

Methods: The study included 1828 carotid endarterectomies performed in 1455 patients between 1996 and 2006. A combination of deep and superficial CPB was used for 1166 procedures, whereas in 662 cases surgery was performed under CE anaesthesia.

Results: The failure rate of CPB was 3% compared with 6.9% for CE anaesthesia (P < 0.0001). The reasons for failure of the anaesthetic techniques were (1) technical failure, (2) insufficient analgesia, (3) non-compliant patients, and (4) anaesthetic complications. The incidence of complications resulting from CE anaesthesia was significantly higher than with CPB; life-threatening complications—2% compared with 0.3% (P < 0.0001); other anaesthesia-related complications 5.7 vs 4.7%. Serious complications included inadvertant injection into the subarachnoid space or vertebral artery. The frequency of shunt insertion, perioperative stroke, and death from any cause was similar in both groups of patients.

Conclusions: Both methods of regional anaesthesia are acceptable for carotid artery surgery. CPB is associated with a significantly lower frequency of anaesthesia-related complications and should therefore be considered the anaesthetic of choice. CE anaesthesia should not be performed except in extenuating circumstances such as variant anatomy or the requirement for more extensive surgery.

Keywords: anaesthetic techniques, epidural; anaesthetic techniques, regional; complications; surgery, endarterectomy


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