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Home > Vascular Annual Meeting > PP2. Patient Cooperation During General Anesthesia...

PP2. Patient Cooperation During General Anesthesia for Carotid Endarterectomy: A Third Anesthetic Option

Carlo Pratesi1, Sergio Bevilacqua2, Stefano Romagnoli2, Francesco Ciappi2, walter dorigo1, Giovanni Pratesi3, John Marek4, Raffaele Pulli1
1University of Florence, Florence, Italy; 2Careggi Hospital, Florence, Italy; 3University of Tor Vergata, Rome, Italy; 4University of New Mexico, Albuquerque, NM

OBJECTIVES: Carotid endarterectomy (CEA) is typically carried out under either regional or general anesthesia. In the present study we analyze a recently developed technique of Cooperative Patient General Anesthesia (Co.Pa.Ge.A.) comparing it with the two conventional techniques of anesthesia.

METHODS: 943 consecutive adult patients scheduled for carotid endarterectomy during the last 3 years were prospectively enrolled in a nonrandomized trial comparing general, loco-regional and Co.Pa.Ge.A anesthetic techniques. Co.Pa.Ge.A. is a general anesthetic technique based on the use of a remifentanil infusion to allow patient cooperation and neurological monitoring during general anesthesia without patient discomfort or anxiety. Standard general anesthesia was performed in 132 patients (Group 1), loco-regional anesthesia in 360 patients (Group 2), and Co.Pa.Ge.A. was achieved in 451 cases (Group 3). The thirty-day rates of stroke, death and cardiac outcomes were analyzed and comparison between the three groups was performed with χ2 test.

RESULTS: No difference was observed in mean patient age or gender between groups. Preoperative neurologic symptoms were present in 237 (25.1%) of patients and 47 (5%) had a contralateral carotid occlusion with no difference between the 3 groups. Co.Pa.Ge.A. was successful in 97.6% of patients requiring conversion to standard general anesthesia in 2.4% because of patient anxiety or temporary neurologic events. Intraoperative stroke occurred in 2 patients (1.5%) in group 1 and in none in the other two groups. Temporary carotid shunts were placed in 39 patients (29.5%) in group 1, 50 (13.9%) group 2 and 68 (15.1%) in group 3 (p<0.001). Fatal and non-fatal myocardial infarction occurred in the early postoperative period in one patient (0.8%) in group 1, in 5 patients (1.4%) in group 2 and 4 patients (0.9%) in group 3, without significant differences. The overall incidence of stroke and death at 30 days from surgery, was 3.8% (5 patients) in group 1 and 0.8% (3 patients) in group 2, whereas no stroke or death was recorded in group 3 (p<0.001 for group 1 vs. groups 2 and 3).

CONCLUSIONS: Cooperative patient general anesthesia is a feasible and safe alternative to standard general and local techniques for CEA with a decreased incidence of stroke and death in the perioperative period.

AUTHOR DISCLOSURES: C. Pratesi, None; S. Bevilacqua, None; S. Romagnoli, None; F. Ciappi, None; W. dorigo, None; G. Pratesi, None; J. Marek, None; R. Pulli, None.