A literature review on anesthetic practice for carotid endarterectomy surgery basd on cost, hemodynamic stability, and neurologic status

AANA Journal/June 2007/Vol. 75, No. 3 193 Carotid endarterectomy is a procedure used to treat severe atherosclerotic occlusive disease involving the internal carotid arteries, most often at the common carotid artery bifurcation. The operation is performed by opening the common carotid arteries and the proximal internal carotid arteries in the neck, removing plaques from the inside of the arteries, and resuturing the wall of the arteries. Opening the carotid artery (arteriotomy) requires temporary occlusion of the proximal common carotid artery, distal internal carotid artery, external carotid artery, and, usually, its first branch, the superior thyroid artery. If the collateral blood flow to the territory supplied by the occluded internal carotid is deemed adequate, the entire procedure can be completed under continued occlusion of these vessels. Alternatively, an intraluminal shunt between the proximal common carotid artery and the distal internal carotid artery can be placed after the arteriotomy for use during the procedure if deemed necessary. The most appropriate type of anesthesia to maintain cerebral blood flow during clamping of the carotid artery continues to be a subject of debate. The 2 main methods used by anesthesia providers are general anesthesia with an endotracheal tube and regional anesthetic block that consists of a deep cervical plexus block and superficial infiltration of local anesthetic. An extensive literature review was undertaken to evaluate the best anesthetic practice for carotid endarterectomy surgery. Two anesthetic techniques were evaluated: general anesthetic with an endotracheal tube and regional anesthetic block. Three variables were reviewed with respect to significant clinical outcomes based on anesthetic technique. Relevant literature was obtained through multiple sources that included professional journals, a professional website, and textbooks. According to the literature, there is an advantage to performing regional anesthesia with respect to cost and neurologic status. Information analyzed was inconclusive with respect to hemodynamic stability and anesthetic technique. We conclude that regional anesthesia may have some slight advantages; however, more investigation is warranted.