Vascular Specialist
Members Only Login
Print this page
Cognitive Dysfunction After CAE Seems Not Due to Anesthesia
By Sherry Boschert
CHICAGO -- Don't blame anesthesia for cognitive dysfunction seen in patients 1 day after carotid endarterectomy, Dr. Eric Heyer said in a poster presentation at the annual meeting of the American Society of Anesthesiologists.
Dr. Heyer and his colleagues at Columbia University, New York, conducted a prospective study of 32 patients who underwent carotid endarterectomy.
All the patients received regional anesthesia with superficial and deep cervical plexus blocks with routine monitors and a radial arterial catheter. Surgeons performed the endarterectomy using monitored anesthesia care with midazolam, fentanyl, and an IV infusion of dexmedetomidine for sedation, said Dr. Heyer, chief of neurosurgical anesthesiology at Columbia.
The control group consisted of 12 patients who underwent coronary or carotid artery angiography or coronary artery stenting, all with sedation.
The investigators chose these patients as controls because they wanted to compare patients with similar vascular disease who received mild sedation, such as that normally used during a carotid endarterectomy, in order to control for any effect caused by the sedation.
All patients were discharged 24 hours after surgery.
To assess cognitive function before and 1 day after surgery, the the researchers used a half-hour battery of five different tests: the Hopkins Verbal Memory Test, Controlled Oral Word Association, the Boston Naming Test, the Rey Complex Figure Test with recall, and the Halstead-Reitan Trail-Making Test parts A and B.
The team analyzed the cognitive function data to generate a mean change in scores in the control group.
Significant cognitive dysfunction in the carotid endarterectomy group was defined as performance that was more than two standard deviations worse than the mean performance of controls.
The results showed that approximately 25% of the carotid endarterectomy patients developed significant cognitive dysfunction, compared with the control group.
A previous study of 196 patients who underwent carotid endarterectomy with general anesthesia also found a 25% incidence of postoperative cognitive dysfunction, compared with a surgical control group, he said.
"Cognitive dysfunction from carotid endarterectomy is therefore independent of the type of anesthetic and is probably due to material coming from the surgical field" that instigates a pathophysiological process, Dr. Heyer concluded.
Society for Vascular Surgery - 633 N. St. Clair, 24th Floor; Chicago, IL 60611; Phone: 312-334-2300 or 800-258-7188; Fax: 312-334-2320; Email: vascular@vascularsociety.org
© 2010 VascularWeb. All rights reserved. Use of the VascularWeb site constitutes acceptance of all of the policies, rules and regulations for the site.
© 2010 VascularWeb. All rights reserved. Use of the VascularWeb site constitutes acceptance of all of the policies, rules and regulations for the site.