Jonggeun Lee1, Up Huh1, Seunghwan Song1, Sung Woon Chung1, Sang Min Sung2, Han Jin Cho2. 1. Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea. 2. Department of Neurology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.
Abstract
Background: Carotid endarterectomy (CEA) is the standard treatment modality for the prevention of stroke in patients with carotid stenosis. This study reports our experiences during CEA with routine awake tests under regional anesthesia (RA) combined with light sedation by dexmedetomidine infusion. Materials and Methods: We retrospectively reviewed 23 patients who had undergone CEA between April 2013 and June 2015. All patients underwent the awake test during CEA with cervical plexus block and light sedation by continuous dexmedetomidine infusion. Results: Mean operation and clamp times were 108.5 ± 20.1 min and 30.1 ± 6.9 min, respectively. Selective shunt placement was performed in three patients (13.0%). There were no cases of perioperative stroke, myocardial infarction, or death. There were no occurrences of residual stenosis, thrombosis, or dissection. One patient had a hypoglossal nerve injury but fully recovered before discharge. Mean (± standard deviation) hospital stay was 7.5 ± 2.6 days. There were no incidences of death, stroke, or restenosis during a mean follow-up period of 9.2 ± 8.8 months. Conclusions: RA with dexmedetomidine infusion appears to be a safe and feasible option. A lower shunt placement rate and favorable patient outcomes were observed following the awake test during CEA.
Background: Carotid endarterectomy (CEA) is the standard treatment modality for the prevention of stroke in patients with carotid stenosis. This study reports our experiences during CEA with routine awake tests under regional anesthesia (RA) combined with light sedation by dexmedetomidine infusion. Materials and Methods: We retrospectively reviewed 23 patients who had undergone CEA between April 2013 and June 2015. All patients underwent the awake test during CEA with cervical plexus block and light sedation by continuous dexmedetomidine infusion. Results: Mean operation and clamp times were 108.5 ± 20.1 min and 30.1 ± 6.9 min, respectively. Selective shunt placement was performed in three patients (13.0%). There were no cases of perioperative stroke, myocardial infarction, or death. There were no occurrences of residual stenosis, thrombosis, or dissection. One patient had a hypoglossal nerve injury but fully recovered before discharge. Mean (± standard deviation) hospital stay was 7.5 ± 2.6 days. There were no incidences of death, stroke, or restenosis during a mean follow-up period of 9.2 ± 8.8 months. Conclusions: RA with dexmedetomidine infusion appears to be a safe and feasible option. A lower shunt placement rate and favorable patient outcomes were observed following the awake test during CEA.
Authors: H J M Barnett; D W Taylor; R B Haynes; D L Sackett; S J Peerless; G G Ferguson; A J Fox; R N Rankin; V C Hachinski; D O Wiebers; M Eliasziw Journal: N Engl J Med Date: 1991-08-15 Impact factor: 91.245
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