RESUMEN
AIM: The aim of this study was to compare by a retrospective analysis local anesthesia (LA) versus general anesthesia (GA) for carotid endarterectomy (CEA). METHODS: Two-hundred and 59 patients who underwent CEA, at the Ospedali Riuniti of Reggio Calabria in the period 2000-2001, were enrolled in this study. For analysis purposes, patients were divided into 4 groups, according to their neurological status and to the type of anesthesia. LA was induced either by deep and superficial cervical plexus block (side approach according to Moore). GA was induced with propofol and maintained with sevoflurane. Monitoring of the neurological status was achieved by simple clinical evaluation of the state of consciousness under LA, and by continuous EEG under GA. RESULTS: With LA, a reduction in the duration of intervention and hospital stay, in the number of neurological complications and consequent intraoperative shunts was observed, and admission to the intensive care unit (ICU) was never required. With GA better blood pressure control was achieved, but more intraoperative shunts and admissions to ICU were required, thus increasing overall costs. CONCLUSION: In our experience, LA seems to be the approach of choice for CEA because 1) by preserving the state of consciousness, it allows a simple clinical monitoring of cerebral perfusion maintenance; 2) it reduces the number of intraoperative shunts and the risk of admission to the ICU; 3) it is cost-effective.
