Preoperative anxiety management: acupuncture vs. pharmacological treatment - A prospective study.

OBJECTIVE: Acupuncture, both auricular and somatic, is a widely adopted and well-tolerated treatment for preoperative anxiety. The aim of our study was to compare the effectiveness of acupuncture with pharmacological treatment in reducing preoperative anxiety in patients undergoing cholecystectomy or TEP. MATERIALS AND METHODS: We randomized 120 patients in a control group PT (where patients underwent pharmacological treatment with Midazolam) and in an acupuncture group (here patients received somatic acupuncture SA and auricular acupuncture AA). Anxiety reduction was measured by intraoperative consumption of Propofol and Fentanyl and preoperatively by the Italian Version of the State-Trait Anxiety Inventory questionnaire (STAI). RESULTS: Propofol consumption in the somatic (SA) and auricular (AA) acupuncture groups was found to be lower compared to patients that did not receive any treatment. SA and AA patients required less Propofol than the PT group (p=0.0019 and p=0.0016 respectively) and patients that underwent SA treatment used less Fentanyl than the PT group (p=0.002). No difference was measured when comparing SA to AA (p=0.15) and AA to PT (p=0.16). CONCLUSIONS: Acupuncture is a safe and well-tolerated procedure that reduces preoperative anxiety. Both somatic and auricular acupuncture are more effective than pharmacological treatment in the intraoperative period. AA is easier to implement than SA.

[Intima flap of the external carotid and postoperative stroke in a patient surgically treated with thromboendarterectomy of the internal carotid]. / Flap intimale della carotide esterna e stroke postoperatorio in paziente operato di tromboendoarteriectomia della carotide interna.

Retrograde thrombosis of the carotid bifurcation rising from an intimal flap of the external carotid artery represent a rare complication of carotid surgery. We present the case of a patient who had undergone carotid thromboendarterectomy (TEA) whose postoperative course was complicated by the appearance of left hemiplegia and coscience disorders. The timely diagnosis of acute carotid thrombosis and the immediate reoperation prevented neurological deficits becoming settled. An attentive intraoperative evaluation of carotid bifurcation showed only the presence of an intimal flap of the external carotid artery from which a big occluding thrombus, involving the bifurcation, rose. The internal and common carotid arteries showed a successful result of the TEA and a good retrograde flow through the internal carotid artery. The authors underline the existence of this perioperative complication and the need for a timely recognition and treatment to avoid serious neurologic consequences.