CAR 2. Multimodal Neurophysiologic Monitoring Reduces Shunt Incidence During Carotid Endarterectomy

The use of a shunt during carotid surgery is controversial. Good results have been found in the literature both with routine use of a shunt and with no shunt during general anesthesia. Other studies report similar results with selective shunting with the support of cerebral monitors. Different experiences are found in the literature with transcranial Doppler (TCD), electroencephalography (EEG), stump pressure (SP), and somatosensory evoked potentials (SSEP). To the best of our knowledge, there are no controlled studies to document the relative efficacy of these techniques.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research

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This study aims to evaluate whether the choice of anesthesia modifies the association between shunting and in-hospital stroke/death after CEA.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
The objective of this study was to determine whether performing carotid endarterectomy (CEA) under locoregional anesthesia reduces the risk of perioperative complications as well as mortality compared with general anesthesia and to investigate an optimal anesthetic technique generally accepted by patients and surgeons for the vascular anesthetists.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
Amit Nagpal, Mohit Mittal, Shalvi Mahajan, Adarsh C SwamiIndian Journal of Anaesthesia 2019 63(10):868-869
Source: Indian Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research
HISTORICALLY, carotid endarterectomy (CEA) surgery has generated several disputes regarding the choice of anesthesia provided and intraoperative neuromonitoring. The landmark General Anesthesia versus Local Anesthesia trial,1 which included 3,526 patients, showed no difference in the occurrence of stroke, myocardial infarction, or death at 30 days after surgery with respect to either local or general anesthesia. Harky et al.2 conducted a systematic review and meta-analysis of general versus local anesthesia in CEA surgery and concluded that each of the anesthetic techniques was noninferior to one another.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
carotid endarterectomy in regional anesthesia is often associated with increased perioperative stress. We assumed, that carotid endarterectomy performed under awake sedation with propofol is more beneficial to prevent such stress than alprazolam premedication only.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research
Purpose of review Outcomes following surgery are of major importance to clinicians, institutions and most importantly patients. This review examines whether regional anesthesia and analgesia influence outcome after vascular surgery. Recent findings Large database analyses of contemporary practice suggest that utilizing regional anesthesia for both open and endovascular aortic aneurysm repair, lower limb revascularization and carotid endarterectomy reduces morbidity, length of stay and possibly even mortality. Results from such analyses are limited by an inherent risk of bias but are nevertheless important given the nu...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: REGIONAL ANESTHESIA: Edited by Nabil Elkassabany Source Type: research
The aim of this study was to investigate the influence of xenon-based anesthesia on somatosensory-evoked potentials.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
The monitoring of regional cerebral oxygen saturation (SrO2) using near-infrared spectroscopy is useful method to detect cerebral ischemia during. Sevoflurane and propofol decrease cerebral metabolic rate (CMRO2)...
Source: BMC Anesthesiology - Category: Anesthesiology Authors: Tags: Research article Source Type: research
A number of awake patients undergoing carotid endarterectomy (CEA) present from test clamp neurological deficits (NDs) during the procedure. Current guidelines advocate tighter Doppler ultrasound (DUS) surveillance in these patients because of probable higher likelihood of hemodynamic stroke (class 1 grade C), although evidence is lacking regarding benefit. The aim for the study is the assumption that patients who present ND have a higher risk of developing a complete stroke if the ipsilateral carotid artery becomes occluded, and for this reason, surveillance over restenosis of endarterectomy in this group is justifiable; ...
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research Source Type: research
A number of awake patients undergoing carotid endarterectomy (CEA) present from test clamp neurological deficits (ND) during the procedure. Current guidelines advocate tighter doppler ultrasound (DUS) surveillance in these patients due to probable higher likelihood of hemodynamic stroke (class 1 grade C), although evidence is lacking regarding benefit. the reasoning for the study is: the assumption that patients who present ND have a higher risk of developing a complete stroke if the ipsilateral carotid artery becomes occluded, and for this reason surveillance over restenosis of endarterectomy in this group is justifiable,...
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research
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