General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis.
J Cardiothorac Vasc Anesth
; 34(1): 219-234, 2020 Jan.
Article
en En
| MEDLINE
| ID: mdl-31072705
ABSTRACT
OBJECTIVE:
The choice of anesthetic technique in carotid endarterectomy (CEA) has been controversial. This study compared the outcomes of general anesthesia (GA) and local anesthesia (LA) in CEA.DESIGN:
Systematic review and meta-analysis of comparative studies.SETTING:
Hospitals.PARTICIPANTS:
Adult patients undergoing CEA with either LA or GA.INTERVENTIONS:
The effects of GA and LA on CEA outcomes were compared. MEASUREMENTS AND MAINRESULTS:
PubMed, OVID, Scopus, and Embase were searched to June 2018. Thirty-one studies with 152,376 patients were analyzed. A random effect model was used, and heterogeneity was assessed with the I2 and chi-square tests. LA was associated with shorter surgical time (weighted mean difference -9.15 min [-15.55 to -2.75]; pâ¯=â¯0.005) and less stroke (odds ratio [OR] 0.76 [0.62-0.92]; pâ¯=â¯0.006), cardiac complications (OR 0.59 [0.47-0.73]; p < 0.00001), and in-hospital mortality (OR 0.72 [0.59-0.90]; pâ¯=â¯0.003). Transient neurologic deficit rates were similar (OR 0.69 [0.46-1.04]; pâ¯=â¯0.07). Heterogeneity was significant for surgical time (I2â¯=â¯0.99, chi-squareâ¯=â¯1,336.04; p < 0.00001), transient neurologic deficit (I2â¯=â¯0.41, chi-squareâ¯=â¯28.81; pâ¯=â¯0.04), and cardiac complications (I2â¯=â¯0.42, chi-squareâ¯=â¯43.32; pâ¯=â¯0.01) but not for stroke (I2â¯=â¯0.22, chi-squareâ¯=â¯30.72; pâ¯=â¯0.16) and mortality (I2â¯=â¯0.00, chi-squareâ¯=â¯21.69; pâ¯=â¯0.65). Randomized controlled trial subgroup analysis was performed, and all the aforementioned variables were not significantly different or heterogenous.CONCLUSION:
The results from this study showed no inferiority of using LA to GA in patients undergoing CEA. Future investigations should be reported more systematically, preferably with randomization or propensity-matched analysis, and thus registries will facilitate investigation of this subject. Anesthetic choice in CEA should be individualized and encouraged where applicable.Palabras clave
Texto completo:
1
Base de datos:
MEDLINE
Asunto principal:
Endarterectomía Carotidea
/
Estenosis Carotídea
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Accidente Cerebrovascular
Tipo de estudio:
Clinical_trials
/
Diagnostic_studies
/
Etiology_studies
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Prognostic_studies
/
Risk_factors_studies
/
Systematic_reviews
Idioma:
En
Revista:
J Cardiothorac Vasc Anesth
Asunto de la revista:
ANESTESIOLOGIA
/
CARDIOLOGIA
Año:
2020
Tipo del documento:
Article