Frawley J E, Hicks R G, Horton D A, Gray L J, Niesche J W, Matheson J M
Department of Vascular and Transplantation Surgery, Prince Henry and Prince of Wales Hospital, University of New South Wales, Sydney, Australia.
J Vasc Surg. 1994 Apr;19(4):732-8. doi: 10.1016/s0741-5214(94)70049-4.
This study reports our experience with thiopental sodium (Pentothal) cerebral protection, without intraluminal shunting, during carotid endarterectomy. Only those complications that occurred during surgery or within 30 days of operation have been addressed.
A prospective, unselected, consecutive series of 621 carotid endarterectomies was done during a 7-year period, with electroencephalography-monitored, high-dose Pentothal for cerebral protection.
Five ischemic strokes (0.8%), completion of two strokes-in-evolution (0.3%) and four strokes caused by cerebral hemorrhage (0.6%) occurred in 11 patients in the perioperative (30-day) period, for a combined cerebral morbidity-mortality rate of 1.7%. Four reversible ischemic neurologic deficits (0.6%) and two transient ischemic attacks (0.3%) in six patients produced a transient deficit rate of 0.9%. Symptomatic coronary artery disease coexisted in 37% of the patients but resulted in only five acute myocardial infarctions (0.7%), one of which was fatal (0.1%). Other perioperative complications in 10 patients (1.5%) were associated with the operative procedure. There were no complications directly attributable to the high-dose Pentothal. Prospective data collection has allowed definition of the disease and cause of all cerebral complications.
The complications in this series have been related to surgical and clinical management problems rather than failure of cerebral protection. Cerebral protection with high-dose Pentothal under electroencephalographic control has been effective and complication free.
本研究报告了我们在颈动脉内膜切除术期间使用硫喷妥钠（喷妥撒）进行脑保护且不进行腔内分流的经验。仅讨论手术期间或术后30天内发生的并发症。
在7年期间对621例颈动脉内膜切除术进行了前瞻性、非选择性、连续系列研究，采用脑电图监测下的高剂量喷妥撒进行脑保护。
围手术期（30天）11例患者发生5例缺血性卒中（0.8%）、2例进展性卒中完成发作（0.3%）和4例脑出血所致卒中（0.6%），脑并发症合并死亡率为1.7%。6例患者出现4例可逆性缺血性神经功能缺损（0.6%）和2例短暂性脑缺血发作（0.3%），短暂性缺损率为0.9%。37%的患者并存有症状性冠状动脉疾病，但仅导致5例急性心肌梗死（0.7%），其中1例死亡（0.1%）。10例患者（1.5%）的其他围手术期并发症与手术操作有关。没有直接归因于高剂量喷妥撒的并发症。前瞻性数据收集使得能够明确所有脑并发症的疾病和病因。
本系列中的并发症与手术和临床管理问题有关，而非脑保护失败。在脑电图控制下使用高剂量喷妥撒进行脑保护是有效的且无并发症。
