Barringer C, Williams JM, McCrirrick A, Earnshaw JJ. Regional anaesthesia and propofol sedation for carotid endarterectomy.
ANZ J Surg 2005;
75:546-9. [PMID:
15972043 DOI:
10.1111/j.1445-2197.2005.03434.x]
[Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND
Many surgeons now perform carotid endarterectomy under regional anaesthesia. The aim of the present study was to review a sedation technique using a computer-controlled infusion of propofol.
METHODS
A consecutive series of 84 carotid endarterectomies done by a single surgeon and commenced under regional anaesthesia with sedation was studied. There were 54 men and 27 women (three bilateral procedures), with a median age of 71 years (range 48-87 years). All patients had carotid stenosis > 70% 80 procedures were done for symptomatic disease and three asymptomatic patients were treated before cardiac surgery (one bilateral).
RESULTS
Seventy-seven procedures were completed under regional anaesthesia and sedation alone; seven required conversion to general anaesthetic, usually for intolerance of the operation. An intraoperative shunt was required on only four occasions (5%). Postoperatively eight patients required critical care monitoring, usually for blood pressure control. The remainder were nursed on the vascular ward, and 68% were discharged home on the day after surgery. No patient died, but there were two neurological complications. One patient had a cerebellar stroke 10 days after surgery, but recovered fully after 4 months. A second developed cerebral oedema due to severe intraoperative hypertension and required intensive care for 15 days. He too recovered fully. Five patients had a further episode of transient cerebral ischaemia within 1 month of operation, but in all cases duplex imaging showed a widely patent carotid and there were no sequelae.
CONCLUSION
Target controlled propofol infusion is an effective method of sedation in patients undergoing carotid endarterectomy.
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