RESUMO
Background: Carotid endarterectomy (CEA) is one of the most effective operations in minimizing stroke risk in both symptomatic and asymptomatic patients with carotid stenosis in the United States. Awake CEA with regional anesthesia may decrease both perioperative complications and length of hospital stay. Techniques of performing awake CEA is not often described in published literature. Objective: To describe our experience with CEA using regional anesthesia with a focus on patient selection, anatomic variations, and surgical technique including cervical regional block. We particularly focus on nuances of the awake approach. Methods: CEA using regional anesthesia is described in detail. Results: Successful use of regional anesthesia during CEA without complication. Conclusion: Regional anesthesia for CEA is an advantageous approach for cervical plaque removal in appropriate patients. Thoughtful patient selection, as well as understanding of anatomy and its variants, is required. Potential advantages and disadvantages are discussed.
RESUMO
Regular exercise improves the cerebrovascular function and has shown considerable therapeutic effects on a wide variety of brain diseases. However, the influence of exercise on different aspects of the cerebrovascular function remains to be comprehensively examined. In this study, we combined awake-brain photoacoustic microscopy (PAM) and a motorized treadmill to assess the effects of both acute exercise stimulation and endurance exercise training on the cerebrovascular function and cerebral oxygen metabolism under both physiological and pathological conditions. Acute exercise stimulation in nondiabetic mice resulted in robust vasodilation, increased cerebral blood flow (CBF), reduced oxygen extraction fraction (OEF), and unchanged cerebral metabolic rate of oxygen (CMRO2)-demonstrating the utility of this experimental setting to evaluate the cerebrovascular reactivity. Also, endurance exercise training for six weeks in diabetic mice reversed the diabetes-induced increases in the resting-state CBF and CMRO2 and maintained a stable OEF and CMRO2 under the acute exercise stimulation-shedding new light on how exercise protects the brain from diabetes-induced small vessel disease. In summary, we established an experimental approach to assess the effects of both acute exercise stimulation and endurance exercise training on the cerebrovascular function and tissue oxygen metabolism at the microscopic level and applied it to study the therapeutic benefits of endurance exercise training in diabetic mice.