Peripheral Vascular Surgery Society

P. Allen Hartsell, MD, Keith D. Calligaro, MD, Jennifer R. Syrek, MD, Matthew J. Dougherty, MD, and Carol A. Raviola, MD

Pennsylvania Hospital, Philadelphia, PA.

Purpose: The purpose of this report was to determine if cervical block anesthesia (CBA) was associated with fewer Hyper- and hypotensive episodes and decreased need for ICU monitoring following CEA than general anesthesia (GA).

Patients and Methods: Between January 1, 1994 and June 30, 1997, 118 CEAs were performed using GA and 116 using CBA. In April 1995, we adopted a change in strategy and switched from routine GA to liberal use of CBA. Infiltration of the carotid body with local anesthesia was not performed in any patient. There were no significant differences between patients undergoing GA vs. CBA in terms of age (avg., 71 vs. 72 years), preoperative hypertension (79% vs. 76%), diabetes mellitus (20% vs. 26%), re-do CEA 8% vs. 6%), or indication for surgery [asymptomatic stenosis > 80% (62% vs. 69%), transient ischemic attack (TIA) (28% vs. 25%), stroke (10% vs. 6%)], respectively (p>0.05). An additional 19 patients who had GA were excluded from analysis [conversion from CBA (10), concomitant coronary bypass (9)].

Results: There were no significant differences in the combined death-stroke rate (GA=1.7%; CBA=2.6%) or incidence of wound hematomas (2.8% for each) between the two groups. However, patients undergoing CBA had significantly fewer postoperative hyper- or hypotensive episodes that required intravenous medication which necessitated overnight ICU monitoring [15%, 18/116 (12 hypertension, 6 hypotension)] than patients undergoing GA [30%, 35/118 (29 hypertension, 6 hypotension)] (p=0.01).

Conclusion: With increasing emphasis in todayâs healthcare market on safety and cost containment, CBA should be considered instead of GA for patients undergoing CEA to decrease significant postoperative hemodynamic changes and the subsequent need for costly intensive care.