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Our results of carotid endarterectomy under cervical block: a first application in an Anatolian medical center

Year 2022, Volume: 13 Issue: 45, 97 - 103, 07.04.2022
https://doi.org/10.17944/mkutfd.1061031

Abstract

Objective: Carotid endarterectomy can be performed under general anesthesia, regional cervical block, combined local-regional or local infiltration anesthesia. The aim of our research is to share our experience of patients who underwent carotid endarterectomy under regional cervical block.
Methods: Between September 2020 and January 2020, a total of 61 patients who underwent carotid endarterectomy were examined retrospectively. The patients’ postoperative early results within the first 30 days were evaluated. Age, sex, risk factors, the usage of shunt, duration of the operation, neurological events, morbidity and mortality were all evaluated.
Results: The data of 61 patients were analyzed retrospectively. Fifteen of the patients were female and forty-six were male. The mean age of the patients was calculated as 61.6±9.1(48-88) years. Fifty-one of the patients were symptomatic. Ten of the patients were asymptomatic, however they had a carotid stenosis of 70 percent or above. In 11 of the 61 patients, carotid endarterectomy was performed bilaterally, so a total of 72 carotid endarterectomies were performed in 61 patients.
The mean duration of the procedure was 77.6±19.7 minutes, and the average time of a clamp on the carotid artery was 29.4±11.5 minutes. Major neurological events, bleeding, infections or death, were seen in none of the discharged patients within 1 month postoperatively.
Conclusion: With increasing experience, carotid endarterectomy can be performed safely under regional cervical block.

References

  • Beyaz MO, Agacfidan A, Onel M, et al. Is there any association between EBV infection and carotid artery stenosis? Cor Vasa 2021;63:535–539
  • Ugurlucan M, Filik ME, Caglar IM, Zencirci E, Sayin OA, Aydiner O, et al. Carotid endarterectomy using a “homeconstructed” shunt for patients intolerant to crossclamping. Surg Today 2015;45(3):284-9.
  • Lomivorotov VV, Shmyrev VA, Nepomniashchikh VA. Regional versus general anesthesia for carotid endarterectomy: do we need another randomized trial?. J Cardiothorac Vasc Anesth 2019 ; 33(4): 943-4.
  • Grieff AN, Dombrovskiy V, Beckerman W, Ventarola D, Truong H, Huntress L et al. Regional anesthesia is associated with cranial nerve ınjury in carotid endarterectomy. Ann Vasc Surg 2020 pii: S0890-5096(20)30010-8. doi: 10.1016/j.avsg.2019.12.033. (Epubahead of print).
  • Vieira-Andrade JD, Rocha-Neves JP, Macedo JP, Dias-Neto MF. onset of neurological deficit during carotid clamping with carotid endarterectomy under regional anesthesia ıs not a predictor of carotid restenosis. Ann Vasc Surg 2019; 61: 193-202.
  • Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. Stroke. 1991 Jun;22(6):816-7. doi: 10.1161/01.str.22.6.816. PMID: 2057984.
  • Bond R, Rerkasem K, Rothwell PM. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Stroke. 2003 Mar;34(3):824-5. doi: 10.1161/01.STR.0000059381.17983.77. Epub 2003 Feb 27. PMID: 12624319.
  • Kalko Y, Kafali E, Aydin U, Kafa U, Kosker T, Basaran M, et al. Surgery of the carotid artery: local anaesthesia versus general anaesthesia. Acta Chir Belg 2007;107(1):53-7.
  • Dakour-Aridi H, Gaber MG, Khalid M, Patterson R, Malas MB. Examination of the interaction between method of anesthesia and shunting with carotidend arterectomy. J Vasc Surg 2019. pii: S0741-5214(19)32305-5. doi: 10.1016/j.jvs.2019.08.248. [Epubahead of print]
  • DakourAridi H, Paracha N, Nejim B, Locham S, Malas MB. Anesthetic type and hospital outcomes after carotid endarterectomy from the Vascular Quality Initiative database. J Vasc Surg 2018 ; 67(5):1419-28.
  • Kim JW, Huh U, Song S, Sung SM, Hong JM, Cho A.Outcomes of carotid endarterectomy according to the anesthetic method: general versus regional anesthesia.Korean J Thorac Cardiovasc Surg 2019; 52(6): 392-9.
  • Siu A, Patel J, Prentice HA, Cappuzzo JM, Hashemi H, Mukherjee D. A Cost Analysis of Regional Versus General Anesthesia for Carotid Endarterectomy. Ann Vasc Surg. 2017 Feb;39:189-194. doi: 10.1016/j.avsg.2016.05.124. Epub 2016 Aug 20. PMID: 27554700.
  • Onur-Beyaz M, Demir İ, Ozer-Ulukan M. Comparison of atherectomy, drug-eluting balloon, and combined treatment efficiency by near infrared spectroscopy. Cir Cir. 2021;89(3):342-346. English. doi: 10.24875/CIRU.20000353. PMID: 34037605.
  • Öztaş DM, Uğurlucan M, Akay HT, Erdinç İ, Aydın K, Alpagut U. Atrial Fibrilasyonu Olan ve Karotis Endarterektomisi Geçiren Hastalarda Postoperatif Antikoagülan ve Antiagregan Stratejisi - Tek Merkez Tecrübesi. J Ist Faculty Med 2019;82(4):174-9
  • Erdinç İ, Öztaş DM, Demir İ, Uğurlucan M, Akay HT. Atriyal fibrilasyon ve karotis arter darlığı birlikteliğinde karotis endarterektomi sonrası medikal tedavi deneyimi. Turk J Vasc Surg 2018;27(2):85-90
  • DaCosta M, Tadi P, Surowiec SM. Carotid Endarterectomy. 2021 Sep 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29261917.
  • Beyaz MO, Ugurlucan M, Oztas DM, et al. Evaluation of the relationship between plaque formation leading to symptomatic carotid artery stenosis and cytomegalovirus by investigating the virus DNA. Arch Med Sci Atheroscler Dis. 2019;4:e19-e24. Published 2019 Mar 4. doi:10.5114/amsad.2019.83304
  • Ugurlucan M, Akay HT, Erdinc I, Oztas DM, Conkbayir C, Aslim E, et al. Anticoagulation Strategy in Patients with Atrial Fibrillation after Carotid Endarterectomy. Acta Chir Belg 2019;119(4):209-16.
  • Gaik C, Wiesmann T. Anästhesie und perioperatives Management der Karotis-Endarteriektomie (CEA) [Anesthetic and Perioperative Management in Carotid Endarterectomy (CEA), Part 1: Anesthetic Procedures]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2022 Jan;57(1):53-66. German. doi: 10.1055/a-1194-0188. Epub 2022 Jan 12. PMID: 35021240.
  • Malik OS, Brovman EY, Urman RD. The use of regional or local anesthesia for carotid endarterectomies may reduce blood loss and pulmonary complications. J Cardiothorac Vasc Anesth 2019; 33(4): 935-42.
  • Pandit JJ, Satya-Krishna R, Gration P. Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications. Br J Anaesth. 2007 Aug;99(2):159-69. doi: 10.1093/bja/aem160. Epub 2007 Jun 18. PMID: 17576970.
  • Hipskind JE, Ahmed AA. Cervical Plexus Block. 2021 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32491314.
  • Ugurlucan M, Onal Y, Oztas DM, Canbay C, Demir I, Sayin OA, et al. Cerebral Protection with a Temporary Ascending Aorta-External Carotid Artery Bypass during Common Carotid Artery Revascularization. Ann Vasc Surg 2018;46:368.e13-368.e17.
  • Bai P, Wang T, Zhou Y, Tao LY, Li G, Li ZQ, Guo XY. [Effect of different shunt strategies on cerebral infarction after carotid endarterectomy]. Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Dec 18;53(6):1144-1151. Chinese. doi: 10.19723/j.issn.1671-167X.2021.06.023. PMID: 34916696; PMCID: PMC8695149.
  • Unal, O. Early results of carotid endarterectomy with local anesthesia. J Ist Faculty Med 2021;84(1):98-103. doi: 10.26650/IUITFD.2020.0003
  • Opperer M, Kaufmann R, Meissnitzer M, Enzmann FK, Dinges C, Hitzl W, Nawratil J, Koköfer A. Depth of cervical plexus block and phrenic nerve blockade: a randomized trial. Reg Anesth Pain Med. 2022 Jan 10:rapm-2021-102851. doi: 10.1136/rapm-2021-102851. Epub ahead of print. PMID: 35012992.
  • Öztaş, DM, Uğurlucan, M., Sayın, Ö. A., Ulukan, M. Ö., Erdinç, İ., Beyaz, MO ... Alpagut, İ. Ü. (2020). Servikal blok alt karotis endarterektomi sonuçlarımız. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi, 24(4), 315-321.
  • Scimia P, Giordano C, Basso Ricci E, Petrucci E, Fusco P. The ultrasound-guided C2-C4 compartment block combined to dexmedetomidine sedation: an ideal approach for carotid endarterectomy in awake patients. Minerva Anestesiol 2018; 84(10): 1226-7.

Servikal blok altında karotis endarterektomi operasyonu sonuçlarımız: Anadolu’da bir merkezde ilk uygulama

Year 2022, Volume: 13 Issue: 45, 97 - 103, 07.04.2022
https://doi.org/10.17944/mkutfd.1061031

Abstract

Amaç: Karotis endarterektomi operasyonu genel anestezi ile uygulanabildiği gibi, bölgesel uygulanabilen; servikal rejyonel blok, lokal-rejyonel kombine anestezi ya da lokal infiltrasyon anestezisi altında yapılabilir. Bu çalışmada rejyonel blok uygulaması ile karotis endarterektomi uygulama deneyimlerimizi sunmayı amaçlıyoruz.
Yöntem: Eylül 2020- Ocak 2022 tarihleri arasında karotis arterine endarterektomi operasyonu yapılan 61 hastanın cerrahi sonrası 30 gün süreyle erken dönem sonuçları retrospektif irdelenmiştir. Hastalara ait yaş, cinsiyet, risk faktörleri, şant kullanımı, operasyon süresi, nörolojik olaylar, mortalite ve morbidite değerlendirilmiştir.
Bulgular: Toplam 61 hastanın verileri retrospektif olarak incelenmiştir. Hastalardan 15’i kadın, 46’sı erkekti. Ortalama yaş 61.6±9.1 (48-88) yıl olarak hesaplandı. Semptomatik hasta sayısı 51 idi. 10 hasta asemptomatik olup stenoz derecesi %70’in üzerindeydi. 11 hastada her iki tarafa endarterektomi uygulandı. Toplam olarak 72 karotis endarterektomi operasyonu gerçekleştirildi.
Ortalama işlem süresi 77.6±19.7 dakika, karotis klemp süresi 29.4±11.5 dakika olarak hesaplandı. Taburcu edilen hiçbir hastada postoperatif ilk ay içinde majör nörolojik olay, kanama, enfeksiyon ya da ölüm ile karşılaşılmadı.
Sonuç: Karotis endarterektomi operasyonu artan tecrübe ile birlikte rejyonel servikal blok altında güvenle gerçekleştirilebilir.

References

  • Beyaz MO, Agacfidan A, Onel M, et al. Is there any association between EBV infection and carotid artery stenosis? Cor Vasa 2021;63:535–539
  • Ugurlucan M, Filik ME, Caglar IM, Zencirci E, Sayin OA, Aydiner O, et al. Carotid endarterectomy using a “homeconstructed” shunt for patients intolerant to crossclamping. Surg Today 2015;45(3):284-9.
  • Lomivorotov VV, Shmyrev VA, Nepomniashchikh VA. Regional versus general anesthesia for carotid endarterectomy: do we need another randomized trial?. J Cardiothorac Vasc Anesth 2019 ; 33(4): 943-4.
  • Grieff AN, Dombrovskiy V, Beckerman W, Ventarola D, Truong H, Huntress L et al. Regional anesthesia is associated with cranial nerve ınjury in carotid endarterectomy. Ann Vasc Surg 2020 pii: S0890-5096(20)30010-8. doi: 10.1016/j.avsg.2019.12.033. (Epubahead of print).
  • Vieira-Andrade JD, Rocha-Neves JP, Macedo JP, Dias-Neto MF. onset of neurological deficit during carotid clamping with carotid endarterectomy under regional anesthesia ıs not a predictor of carotid restenosis. Ann Vasc Surg 2019; 61: 193-202.
  • Clinical alert: benefit of carotid endarterectomy for patients with high-grade stenosis of the internal carotid artery. National Institute of Neurological Disorders and Stroke Stroke and Trauma Division. North American Symptomatic Carotid Endarterectomy Trial (NASCET) investigators. Stroke. 1991 Jun;22(6):816-7. doi: 10.1161/01.str.22.6.816. PMID: 2057984.
  • Bond R, Rerkasem K, Rothwell PM. Routine or selective carotid artery shunting for carotid endarterectomy (and different methods of monitoring in selective shunting). Stroke. 2003 Mar;34(3):824-5. doi: 10.1161/01.STR.0000059381.17983.77. Epub 2003 Feb 27. PMID: 12624319.
  • Kalko Y, Kafali E, Aydin U, Kafa U, Kosker T, Basaran M, et al. Surgery of the carotid artery: local anaesthesia versus general anaesthesia. Acta Chir Belg 2007;107(1):53-7.
  • Dakour-Aridi H, Gaber MG, Khalid M, Patterson R, Malas MB. Examination of the interaction between method of anesthesia and shunting with carotidend arterectomy. J Vasc Surg 2019. pii: S0741-5214(19)32305-5. doi: 10.1016/j.jvs.2019.08.248. [Epubahead of print]
  • DakourAridi H, Paracha N, Nejim B, Locham S, Malas MB. Anesthetic type and hospital outcomes after carotid endarterectomy from the Vascular Quality Initiative database. J Vasc Surg 2018 ; 67(5):1419-28.
  • Kim JW, Huh U, Song S, Sung SM, Hong JM, Cho A.Outcomes of carotid endarterectomy according to the anesthetic method: general versus regional anesthesia.Korean J Thorac Cardiovasc Surg 2019; 52(6): 392-9.
  • Siu A, Patel J, Prentice HA, Cappuzzo JM, Hashemi H, Mukherjee D. A Cost Analysis of Regional Versus General Anesthesia for Carotid Endarterectomy. Ann Vasc Surg. 2017 Feb;39:189-194. doi: 10.1016/j.avsg.2016.05.124. Epub 2016 Aug 20. PMID: 27554700.
  • Onur-Beyaz M, Demir İ, Ozer-Ulukan M. Comparison of atherectomy, drug-eluting balloon, and combined treatment efficiency by near infrared spectroscopy. Cir Cir. 2021;89(3):342-346. English. doi: 10.24875/CIRU.20000353. PMID: 34037605.
  • Öztaş DM, Uğurlucan M, Akay HT, Erdinç İ, Aydın K, Alpagut U. Atrial Fibrilasyonu Olan ve Karotis Endarterektomisi Geçiren Hastalarda Postoperatif Antikoagülan ve Antiagregan Stratejisi - Tek Merkez Tecrübesi. J Ist Faculty Med 2019;82(4):174-9
  • Erdinç İ, Öztaş DM, Demir İ, Uğurlucan M, Akay HT. Atriyal fibrilasyon ve karotis arter darlığı birlikteliğinde karotis endarterektomi sonrası medikal tedavi deneyimi. Turk J Vasc Surg 2018;27(2):85-90
  • DaCosta M, Tadi P, Surowiec SM. Carotid Endarterectomy. 2021 Sep 29. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29261917.
  • Beyaz MO, Ugurlucan M, Oztas DM, et al. Evaluation of the relationship between plaque formation leading to symptomatic carotid artery stenosis and cytomegalovirus by investigating the virus DNA. Arch Med Sci Atheroscler Dis. 2019;4:e19-e24. Published 2019 Mar 4. doi:10.5114/amsad.2019.83304
  • Ugurlucan M, Akay HT, Erdinc I, Oztas DM, Conkbayir C, Aslim E, et al. Anticoagulation Strategy in Patients with Atrial Fibrillation after Carotid Endarterectomy. Acta Chir Belg 2019;119(4):209-16.
  • Gaik C, Wiesmann T. Anästhesie und perioperatives Management der Karotis-Endarteriektomie (CEA) [Anesthetic and Perioperative Management in Carotid Endarterectomy (CEA), Part 1: Anesthetic Procedures]. Anasthesiol Intensivmed Notfallmed Schmerzther. 2022 Jan;57(1):53-66. German. doi: 10.1055/a-1194-0188. Epub 2022 Jan 12. PMID: 35021240.
  • Malik OS, Brovman EY, Urman RD. The use of regional or local anesthesia for carotid endarterectomies may reduce blood loss and pulmonary complications. J Cardiothorac Vasc Anesth 2019; 33(4): 935-42.
  • Pandit JJ, Satya-Krishna R, Gration P. Superficial or deep cervical plexus block for carotid endarterectomy: a systematic review of complications. Br J Anaesth. 2007 Aug;99(2):159-69. doi: 10.1093/bja/aem160. Epub 2007 Jun 18. PMID: 17576970.
  • Hipskind JE, Ahmed AA. Cervical Plexus Block. 2021 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 32491314.
  • Ugurlucan M, Onal Y, Oztas DM, Canbay C, Demir I, Sayin OA, et al. Cerebral Protection with a Temporary Ascending Aorta-External Carotid Artery Bypass during Common Carotid Artery Revascularization. Ann Vasc Surg 2018;46:368.e13-368.e17.
  • Bai P, Wang T, Zhou Y, Tao LY, Li G, Li ZQ, Guo XY. [Effect of different shunt strategies on cerebral infarction after carotid endarterectomy]. Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Dec 18;53(6):1144-1151. Chinese. doi: 10.19723/j.issn.1671-167X.2021.06.023. PMID: 34916696; PMCID: PMC8695149.
  • Unal, O. Early results of carotid endarterectomy with local anesthesia. J Ist Faculty Med 2021;84(1):98-103. doi: 10.26650/IUITFD.2020.0003
  • Opperer M, Kaufmann R, Meissnitzer M, Enzmann FK, Dinges C, Hitzl W, Nawratil J, Koköfer A. Depth of cervical plexus block and phrenic nerve blockade: a randomized trial. Reg Anesth Pain Med. 2022 Jan 10:rapm-2021-102851. doi: 10.1136/rapm-2021-102851. Epub ahead of print. PMID: 35012992.
  • Öztaş, DM, Uğurlucan, M., Sayın, Ö. A., Ulukan, M. Ö., Erdinç, İ., Beyaz, MO ... Alpagut, İ. Ü. (2020). Servikal blok alt karotis endarterektomi sonuçlarımız. İzmir Eğitim ve Araştırma Hastanesi Tıp Dergisi, 24(4), 315-321.
  • Scimia P, Giordano C, Basso Ricci E, Petrucci E, Fusco P. The ultrasound-guided C2-C4 compartment block combined to dexmedetomidine sedation: an ideal approach for carotid endarterectomy in awake patients. Minerva Anestesiol 2018; 84(10): 1226-7.
There are 28 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Original Articles
Authors

Metin Onur Beyaz 0000-0001-9338-8152

Senem Urfalı 0000-0003-4500-2408

Sefer Kaya This is me 0000-0003-2814-5327

Dilan Oruç This is me 0000-0002-7609-1100

Mehmet Çömez 0000-0003-0821-5148

Sedat Hakimoğlu 0000-0002-1556-7996

Onur Koyuncu 0000-0002-0282-181X

Ismet Melek 0000-0002-0599-4695

İyad Fansa 0000-0002-5390-5511

Publication Date April 7, 2022
Submission Date January 21, 2022
Acceptance Date March 14, 2022
Published in Issue Year 2022 Volume: 13 Issue: 45

Cite

Vancouver Beyaz MO, Urfalı S, Kaya S, Oruç D, Çömez M, Hakimoğlu S, Koyuncu O, Melek I, Fansa İ. Servikal blok altında karotis endarterektomi operasyonu sonuçlarımız: Anadolu’da bir merkezde ilk uygulama. mkutfd. 2022;13(45):97-103.