October 18, 2022
Abstract:
Recent evidence suggests no difference between patient outcomes when carotid endarterectomies (CEAs) are performed under general or regional anesthesia. However, for detecting the need for a shunt, general anesthesia has the drawback of monitoring needs in the intraoperative setting. In the present study, we attempted to perform intraoperative transcranial Doppler (TCD) mon- itoring for CEAs performed under intermediate plexus block to describe cerebral hemodynamic changes during different phases of the procedure.
Patients and methods:
Patients with unilateral hemo- dynamically significant carotid stenosis scheduled for elective CEAs were included. Ultrasound-guided inter- mediate plexus block was used for regional anesthesia. TCD monitoring of the middle cerebral artery mean blood flow velocity (MCAV) was performed throughout the pro- cedure. MCAVs were offline analyzed during different phases of CEA: (1) resting state, before regional block, (2) after block, before incision, (3) before cross-clamp, (4) after cross-clamp, (5) 5 min after cross-clamp, (6) 10 min after cross-clamp, (7) after declamping, and (8) during the postoperative period (4–6 h).
Results:
Shunt insertion based on the deterioration of neurological symptoms after cross-clamping was neces- sary for 11/66 patients (16.6%). In these symptomatic patients, the ipsilateral percent decrease of the MCAV was more than 70% in 8 out of 11 cases (72.7%). In asymp- tomatic patients, without shunt insertion, the average decrease of MCAV was less than 50%.
Conclusions:
Neurological symptoms referring to cer- ebral ischemia may be superior to TCD monitoring of cerebral blood flow for detecting the necessity of a shunt. Regional anesthesia enables reliable, symptom-based monitoring of CEAs.
Keywords:
carotid endarterectomy, regional anesthesia, transcranial Doppler monitoring.
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