Rössel T, Litz R J, Heller A R, Koch T
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Dresden, Fetscherstrasse 74, 01307 Dresden.
Anaesthesist. 2008 Feb;57(2):115-30. doi: 10.1007/s00101-008-1312-3.
Carotid endarterectomy (CEA) has remained the first choice of treatment in preventing ischemic stroke due to symptomatic stenosis of the internal carotid artery despite other new available options. During CEA patients are first and foremost at risk of cerebral as well as myocardial ischemia, therefore, maintenance of the oxygen supply to the brain and the myocardium is of outstanding importance requiring reliable monitoring of cerebral and cardiac function. The regional versus general anesthesia debate is an age-old one that has brought few definite answers regarding the impact on postoperative outcome of either anesthetic technique. Up to now, there is little evidence from only a few randomized clinical trials to demonstrate the superiority of either anesthetic technique with respect to outcome parameters. Because the level of evidence in favor of regional anesthesia during CEA can at least be rated between 1(-) and 2(+) the resulting recommendation is grade C. The purpose of the review is to highlight the characteristics and goals of anesthetic management during CEA.
尽管有其他新的可用治疗方法，但颈动脉内膜切除术（CEA）仍然是预防因症状性颈内动脉狭窄导致缺血性卒中的首选治疗方法。在CEA手术期间，患者首先面临脑缺血和心肌缺血的风险，因此，维持大脑和心肌的氧气供应至关重要，这需要对脑功能和心脏功能进行可靠的监测。区域麻醉与全身麻醉的争论由来已久，但关于这两种麻醉技术对术后结果的影响，几乎没有明确的答案。到目前为止，仅有少数随机临床试验的证据很少能证明哪种麻醉技术在结果参数方面具有优越性。由于支持CEA手术期间采用区域麻醉的证据水平至少可评为1（-）到2（+），因此得出的推荐等级为C级。本综述的目的是强调CEA手术期间麻醉管理的特点和目标。
