Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy -
Section of Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Int Angiol. 2020 Dec;39(6):477-484. doi: 10.23736/S0392-9590.20.04427-2.
Carotid endarterectomy (CEA) can be performed both under general anesthesia (GA) or local anesthesia (LA) with good results. General anesthesia with preserved consciousness (GAPC) using remifentanil infusion has been already reported in literature and could potentially merge the advantages of GA and LA overcoming the disadvantages of this last technique. Although the good results of GAPC reported in literature, this technique is not widespread in clinical practice. The aim of this study was to report the perioperative results of CEA under GAPC in a large series of consecutive patients.
This is a retrospective, single center, observational study including all patients treated for CEA under GAPC in our institution between January 2008 and October 2019. Primary endpoints were neurological complications rate, mortality rate in the perioperative period, need to GAPC conversion to GA during surgery and evaluation of the technique with a specific questionnaire regarding patients' satisfaction. Secondary endpoints were myocardial infarction (MI) rate, other perioperative complications rate, rate of intraoperative shunting and need of reintervention in the perioperative period.
In the considered period 1290 CEA under GAPC were performed and included in this study. Neurological complications rate was 2.01%, mortality rate in the perioperative period was 0.07%, need of GAPC conversion to GA rate during surgery was 0.46% and patients satisfaction regarding the technique were high with a mean vote of 9.1 in a 0 to 10 scale. In the perioperative period MI rate was 0.23%, other perioperative complications rate was 1.39%, intraoperative shunting rate was 7.1% and reintervention rate after surgery was 2.4%.
CEA under GAPC may combine the advantages of LA and GA, with a very low rate of conversion to GA during surgery and good patients' satisfaction. Moreover, it does not increase neurological, cardiologic and systemic complications. For these reasons CEA under GAPC could represents a valid alternative to GA or LA.
颈动脉内膜切除术（CEA）可在全身麻醉（GA）或局部麻醉（LA）下进行，效果良好。文献中已经报道了使用瑞芬太尼输注的保留意识的全身麻醉（GAPC），并且可以潜在地融合 GA 和 LA 的优点，克服后者的缺点。尽管文献报道了 GAPC 的良好结果，但该技术在临床实践中并不广泛。本研究的目的是报告在大量连续患者中使用 GAPC 进行 CEA 的围手术期结果。
这是一项回顾性、单中心、观察性研究，纳入了 2008 年 1 月至 2019 年 10 月期间在我院接受 GAPC 治疗的所有 CEA 患者。主要终点是神经并发症发生率、围手术期死亡率、术中需要将 GAPC 转换为 GA 的发生率以及使用特定问卷评估该技术的患者满意度。次要终点是心肌梗死（MI）发生率、其他围手术期并发症发生率、术中分流率和围手术期需要再次干预的发生率。
在所考虑的时间段内，共进行了 1290 例 GAPC 治疗的 CEA，并纳入本研究。神经并发症发生率为 2.01%，围手术期死亡率为 0.07%，术中需要将 GAPC 转换为 GA 的发生率为 0.46%，患者对该技术的满意度较高，平均得分为 9.1（0 到 10 分）。在围手术期，MI 发生率为 0.23%，其他围手术期并发症发生率为 1.39%，术中分流率为 7.1%，术后再次干预率为 2.4%。
GAPC 下的 CEA 可能结合了 LA 和 GA 的优点，术中转换为 GA 的比例非常低，患者满意度高。此外，它不会增加神经、心脏和全身并发症。因此，GAPC 下的 CEA 可以作为 GA 或 LA 的有效替代方法。
