Kim Jong Won, Huh Up, Song Seunghwan, Sung Sang Min, Hong Jung Min, Cho Areum
Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea.
Department of Neurology, Pusan National University Hospital, Biomedical Research Institute, Pusan National University School of Medicine, Busan, Korea.
Korean J Thorac Cardiovasc Surg. 2019 Dec;52(6):392-399. doi: 10.5090/kjtcs.2019.52.6.392. Epub 2019 Dec 5.
The surgical strategies for carotid endarterectomy (CEA) vary in terms of the anesthesia method, neurological monitoring, shunt usage, and closure technique, and no gold-standard procedure has been established yet. We aimed to analyze the feasibility and benefits of CEA under regional anesthesia (RA) and CEA under general anesthesia (GA).
Between June 2012 and December 2017, 65 patients who had undergone CEA were enrolled, and their medical records were prospectively collected and retrospectively reviewed. A total of 35 patients underwent CEA under RA with cervical plexus block, whereas 30 patients underwent CEA under GA. In the RA group, a carotid shunt was selectively used for patients who exhibited negative results on the awake test. In contrast, such a shunt was used for all patients in the GA group.
There were no cases of postoperative stroke, cardiovascular events, or mortality. Nerve injuries were noted in 4 patients (3 in the RA group and 1 in the GA group), but they fully recovered prior to discharge. Operative time and clamp time were shorter in the RA group than in the GA group (119.29±27.71 min vs. 161.43±20.79 min, p<0.001; 30.57±6.80 min vs. 51.77±13.38 min, p<0.001, respectively). The hospital stay was shorter in the RA group than in the GA group (14.6±5.05 days vs. 18.97±8.92 days, p=0.022). None of the patients experienced a stroke or restenosis during the 27.23±20.3-month follow-up period.
RA with a reliable awake test reduces shunt use and decreases the clamp and operative times of CEA, eventually resulting in a reduced length of hospital stay.
颈动脉内膜切除术（CEA）的手术策略在麻醉方法、神经监测、分流管使用和闭合技术方面存在差异，目前尚未确立金标准术式。我们旨在分析区域麻醉（RA）下CEA和全身麻醉（GA）下CEA的可行性和益处。
2012年6月至2017年12月期间，纳入65例行CEA的患者，前瞻性收集并回顾其病历。35例患者在RA下行颈丛阻滞CEA，30例患者在GA下行CEA。RA组中，清醒试验结果为阴性的患者选择性使用颈动脉分流管。相比之下，GA组所有患者均使用分流管。
无术后卒中、心血管事件或死亡病例。4例患者出现神经损伤（RA组3例，GA组1例），但出院前均完全恢复。RA组的手术时间和夹闭时间短于GA组（分别为119.29±27.71分钟对161.43±20.79分钟，p<0.001；30.57±6.80分钟对51.77±13.38分钟，p<0.001）。RA组的住院时间短于GA组（14.6±5.05天对18.97±8.92天，p=0.022）。在27.23±20.3个月的随访期内，所有患者均未发生卒中或再狭窄。
可靠的清醒试验下的RA减少了分流管的使用，缩短了CEA的夹闭和手术时间，最终缩短了住院时间。
