Perioperative outcome of carotid endarterectomy with regional anesthesia: two decades of experience from the Caribbean

STUDY OBJECTIVE: To evaluate the perioperative outcome of carotid endarterectomy (CEA) with regional anesthesia. DESIGN: Retrospective chart review of consecutive patients who underwent CEA with regional anesthesia in a 23-year period. SETTING: Operating rooms of a general hospital in a developing country. MEASUREMENTS: Demographic data, perioperative clinical data, postoperative morbidity and unplanned admissions were recorded. MAIN RESULTS: A total of 183 CEA procedures were performed. In 172 cases, CEA was done exclusively with deep cervical plexus block and local infiltration, while in 11 (6%) cases, there was a need for conversion to general anesthesia intraoperatively. Clamping of the internal carotid artery (ICA) for a three-minute period was the method used to monitor any development of neurological impairment. Perioperative complications included intraoperative seizures in one patient, intraoperative transient hemiparesis in three patients, postoperative transient hemiparesis in two patients, and intraoperative hemiplegia in one patient. One hundred fifty-three patients (83.6%) were discharged home within 24 hours, and 29 (15.8%) were discharged home in 48 hours. The hemiplegic patient had a hospital stay of 12 days. There was no perioperative mortality. CONCLUSIONS: Regional anesthesia is a safe method for CEA in a limited-resources setting, as it facilitates intraoperative clinical assessment of the effects of ICA clamping.

Perioperative outcome of carotid endarterectomy with regional anesthesia: two decades of experience from the Caribbean.

STUDY OBJECTIVE: To evaluate the perioperative outcome of carotid endarterectomy (CEA) with regional anesthesia. DESIGN: Retrospective chart review of consecutive patients who underwent CEA with regional anesthesia in a 23-year period. SETTING: Operating rooms of a general hospital in a developing country. MEASUREMENTS: Demographic data, perioperative clinical data, postoperative morbidity and unplanned admissions were recorded. MAIN RESULTS: A total of 183 CEA procedures were performed. In 172 cases, CEA was done exclusively with deep cervical plexus block and local infiltration, while in 11 (6%) cases, there was a need for conversion to general anesthesia intraoperatively. Clamping of the internal carotid artery (ICA) for a three-minute period was the method used to monitor any development of neurological impairment. Perioperative complications included intraoperative seizures in one patient, intraoperative transient hemiparesis in three patients, postoperative transient hemiparesis in two patients, and intraoperative hemiplegia in one patient. One hundred fifty-three patients (83.6%) were discharged home within 24 hours, and 29 (15.8%) were discharged home in 48 hours. The hemiplegic patient had a hospital stay of 12 days. There was no perioperative mortality. CONCLUSIONS: Regional anesthesia is a safe method for CEA in a limited-resources setting, as it facilitates intraoperative clinical assessment of the effects of ICA clamping.

Cortical visual loss in a young woman with systemic lupus erythematosus

A 29-year old West Indian woman presented with a one year history of gradual visual loss. There was a past history of psychiatric illness. Examination revealed normal optic nerve function bilaterally. The retinae appeared healthy. Visual acuities were down. A computed tomography brain scan showed mark cerebral atrophy particularly in the occipital areas. The ESR was elevated at 111 mm, Westergen, 1st hour. The ANF was strongly positive. A diagnosis of cerebral lupus was made. The patient has been started on immunosuppressive therapy. (AU)

Nutritional amblyopia in a 32-year-ld male [abstract]

A 32-year-old Caucasian man presented with a 6 month history of gradual visual loss. He lived alone and consumed large quantities of alcohol. In addition, he smoked heavily and had only one meal per day. Examination revealed poor visual acuities bilaterally, with normal looking optic discs and retina. An MRI brain scan was normal. Visual evoked potentials showed small P100 responses. His mean corpuscular volume was elevated as was the gammaglutamyl transpeptidase. The patient was started on high dose vitamin B. His visual acuities are improving. (AU)

The Guillain-Barre syndrome following dengue fever

A 44 year old female presented with fever, muscle aches, rash and a low platelet count. IgM antibody to dengue virus was positive. Two weeks later she developed a flaccid areflexic quadriparesis. Nerve conduction studies showed a predominantly demyelitinating sensory motor polyneuropathy consistent with Guillain-Barre syndrome. Despite the relatively common occurence of dengue fever, an associated polyradiculoneuropathy is distinctly uncommon.(AU)

Neural tube defects in Trinidad - abstract

All cases of neural tube defects (NTD) at the Port-of-Spain General and Mount Hope Hospital for Women from June 1980 to July 1983 were studied retrospectively with respect to sex distribution, ethnic group, social class of parents, area of residence, birth weight, birth order, maternal age, associated congenital abnormalities, family history, annual incidence and other factors. There were 71 NTD with no sex predominance. Twenty-six were of African descent and 38 of East Indian descent and 7 of mixed ethnic origin. The incidence in Trinidad of NTD per thousand total births 1.52 overall, 1.40 in the African and 2.05 in the East Indian, was much lower than in countries of similar ethnic groups - 2.74 Pretoria, South Africa in the Bantu and 3.75 in Bombay, India. In Trinidad, the incidence of anencephalus was particularly low in the African. The incidence of hydrocephalus, hydrocephalus with spina bifida, occiptal meningocele and other neural tube defects was about the same in both ethnic groups, while spina bifida incidence was relatively higher in the East Indian. Those of African descent were clustered in the Belmont-Laventille-Morvant area, while those of East Indian descent were clustered in the Chaguanas and in the San Juan to Tunapuna area, and the occurence in these areas was disproportionately high and not totally explained by population distribution. Other positive findings were low birth weight and being first-born with anencephalus, and social classes 4 and 5 in parents of patients with NTD. This study shows a low Trinidad incidence of NTD, differing ethnic incidence and distribution, and suggests a multifcatorial aetiology (AU)