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Local versus general anaesthesia for carotid endarterectomy

  1. Tanat Vaniyapong1,
  2. Wilaiwan Chongruksut1,
  3. Kittipan Rerkasem1,2,*

Editorial Group: Cochrane Stroke Group

Published Online: 19 DEC 2013

Assessed as up-to-date: 30 SEP 2013

DOI: 10.1002/14651858.CD000126.pub4


How to Cite

Vaniyapong T, Chongruksut W, Rerkasem K. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD000126. DOI: 10.1002/14651858.CD000126.pub4.

Author Information

  1. 1

    Chiang Mai University, Department of Surgery, Faculty of Medicine, Chiang Mai, Thailand

  2. 2

    Chiang Mai University, Center for Applied Science, Research Institute of Health Sciences, Chiang Mai, Thailand

*Kittipan Rerkasem, rerkase@gmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 19 DEC 2013

SEARCH

References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Binder 1999 {published and unpublished data}
  • Binder M, Fitzgerald R, Fried H, Schwarz S. Carotid endarterectomy surgery in cervical block: an economic alternative to general anaesthesia? [Karotisdesobliteration in cervicalisblockade: eine okonomische alternative zur vollnarkose?]. Gesundheitsökonomie und Qualitätsmanagement 1999;4:19-24.
Forssell 1989 {published data only}
  • Forssell C. Studies on risks and results in carotid artery surgery [dissertation]. Malmo, Sweden: Lund University, 1991.
  • Forssell C, Takolander R, Bergqvist D, Johansson A, Persson NH. Local versus general anaesthesia in carotid surgery. A prospective, randomised study. European Journal of Vascular Surgery 1989;3:503-9.
  • Takolander R, Bergqvist D, Hulthen L, Johansson A, Katzman PL. Carotid artery surgery. Local versus general anaesthetic as related to sympathetic activity and cardiovascular effects. European Journal of Vascular Surgery 1990;4:265-70.
GALA 2008 {published and unpublished data}
  • GALA Trial Collaborative Group. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 2008;372:2132-42.
  • Girn HRS, Dellagrammaticas D, Laughlan K, Gough MJ, GALA Trial Collaborators. Carotid endarterectomy: technical practices of surgeons participating in the GALA trial. European Journal of Vascular and Endovascular Surgery 2008;36:385-9.
  • Gomes M, Soares MO, Dumville JC, Lewis SC, Torgerson DJ, Bodenham AR, GALA Collaborative Group. Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery (GALA Trial). British Journal of Surgery 2010;97:1218-25.
  • Gough MJ, Bodenham A, Horrocks M, Colam B, Lewis SC, Rothwell PM, et. al. GALA: an international multicentre randomised trial comparing general anaesthesiaversus local anaesthesia for carotid surgery. Trials 2008:doi: 10.1186/1745-6215-9-28.
  • Gough MJ, GALA trial Collaborators. The GALA trial - a summary of the findings. European Journal of Vascular and Endovascular Surgery 2008;36:505-6.
  • Weber CF, Friedl H, Hueppe M, Hintereder G, Schmitz-Rixen T, Zwissler B, et al. Impact of general versus local anesthesia on early postoperative cognitive dysfunction following carotid endarterectomy: GALA study subgroup analysis. World Journal of Surgery 2009;33:1526-32.
  • Wijeyaratne SM, Collins MA, Barth JH, Gough MJ. Jugular venous neurone specific enolase (NSE) increases following carotid endarterectomy under general, but not local, anaesthesia. European Journal of Vascular and Endovascular Surgery 2009;38:262-6.
Gimenez 2004 {published data only}
  • Gimenez A, Gonzales E, Lloret MD, Hospedales J, Bellmunt S, Vallespin J, et al. A comparison of general anaesthesia and loco-regional anaesthesia in surgery of the internal carotid artery and its repercussion on haemodynamic control. Cardiovascular Surgery 2003;11(Suppl 2):97.
Kasprzak 2006 {published and unpublished data}
  • Kasprzak P, Altmeppen J, Rosin L, Metz CH, Horn M, Jauch KW. Local versus general anaesthesia in carotid surgery - results of a prospective randomised study. Cardiovascular Surgery 1999;7(Suppl 1):16.
  • Kasprzak PM, Altmeppen J, Angerer M, Mann S, Mackh J, Topel J. General versus locoregional anesthesia in carotid surgery: a prospective randomised trial. VASA 2006;35:232-8.
Luchetti 2008 {published data only}
  • Luchetti M, Canella M, Zoppi M, Massei R. Comparison of regional anesthesia versus combined regional and general anesthesia for elective carotid endarterectomy: a small exploratory study. Regional Anesthesia and Pain Medicine 2008;33:340-5.
Mazul-Sunko 2010 {published and unpublished data}
  • Mazul-Sunko B, Hromatko I, Tadinac M, Sekulic A, Ivanec Z, Gvozdenovic A, et al. Subclinical neurocognitive dysfunction after carotid endarterectomy - the impact of shunting. Journal of Neurosurgical Anesthesiology 2010;22:195-201.
McCarthy 2004 {published data only}
  • McCarthy RJ, Nasr MK, McAteer P, Horrocks M. Physiological advantages of cerebral blood flow during carotid endarterectomy under local anaesthesia.. European Journal of Vascular and Endovascular Surgery 2002;24:215-21.
  • McCarthy RJ, Trigg R, John C, Gough MJ, Horrocks M. Patient satisfaction for carotid endarterectomy performed under local anaesthesia. European Journal of Vascular and Endovascular Surgery 2004;27:654-9.
Moritz 2010 {published data only}
  • Moritz S, Schmidt C, Bucher M, Wiesenack C, Zimmermann M, Schebesch KM, et al. Neuromonitoring in carotid surgery: are the results obtained in awake patients transferable to patients under sevoflurane/fentanyl anesthesia?. Journal of Neurosurgical Anesthesiology 2010;22:288-95.
Mrozek 2007 {published data only}
  • Mrozek Z, Koutna J, Marek O. Anesthesia options in carotid endarterectomy. Anesteziologie a Intenzivni Medicina 2007;18:202-9.
Pluskwa 1989 {published data only}
  • Pluskwa F, Bonnet F, Abhay K, Touboul C, Rey B, Marcandoro J, et al. Blood pressure profiles during carotid endarterectomy. Comparing flunitrazepam/fentanyl/nitrous oxide with epidural anaesthesia (author's translation). Annales Françaises d'Anesthèsie et de Rèanimation 1989;8:26-32.
Prough 1989 {published data only}
  • Prough DS, Scuderi PE, McWhorter JM, Balestrieri FJ, Davis CH, Stullken EH. Hemodynamic status following regional and general anesthesia for carotid endarterectomy. Journal of Neurosurgical Anesthesiology 1989;1:35-40.
Sbarigia 1999 {published and unpublished data}
  • Sbarigia E, DarioVizza C, Antonini M, Speziale F, Maritti M, Fiorani B, et al. Locoregional versus general anesthesia in carotid surgery: is there an impact on perioperative myocardial ischemia? Results of a prospective monocentric randomized trial. Journal of Vascular Surgery 1999;30:131-8.
  • Vizza C, Sbarigia E, Antonini M, Speziale F, Maritti M, Fiorani B, et al. Perioperative myocardial ischemia in patients treated with carotid surgery. Impact of the type of anesthesia (locoregional vs general). Minerva Cardioangiologica 1999;47(12):626-7.
Sindelic 2004 {published data only}
  • Sindelic R, Viajkovic G, Davidovic L, Vujanac B, Vjestica M. Comparison of the influence of general and regional anesthesia on basic haemodynamic parameters during carotid endarterectomy. Acta Chirurgica Iugoslavica 2004;51:37-43.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Ebner 2008 {published data only}
  • Ebner FH, Trenti E, Baldinelli F, Natto M, Ebner H. Carotid endarterectomy: comparing anesthesia in awakened and intubated patients with general anesthesia. Minerva Cardioangiologica 2008;56(5 Suppl):29-34.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
APT 1994
  • Antiplatelet Trialists Collaboration. Collaborative overview of trials of antiplatelet therapy - I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ 1994;308:81-106.
Bass 1989
  • Bass A, Krupski WC, Schneider PA, Otis SM, Dilley RB, Bernstein EF. Intraoperative transcranial doppler: limitations of the method. Journal of Vascular Surgery 1989;10:549-53.
Becquemin 1991
  • Becquemin JP, Paris E, Valverde A, Pluskwa F, Melliere D. Carotid surgery. Is regional anesthesia always appropriate?. Journal of Cardiovascular Surgery 1991;32:592-8.
Benjamin 1993
  • Benjamin ME, Silva MB, Watt C, McCaffrey MT, Burford-Foggs A, Flinn WR. Awake patient monitoring to determine the need for shunting during carotid endarterectomy. Surgery 1993;114:673-81.
Buche 1988
  • Buche M, Grenier Y, Schoevaerdts JC, Jaumin P, Ponlot R, Chalant CH. Comparative results after endarterectomy of internal carotid artery performed with or without a shunt. Journal of Cardiovascular Surgery 1988;29:428-31.
Collins 2001
Corson 1987
ECST 1991
  • European Carotid Surgery Trialists Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet 1991;337:1235-43.
Gnanadev 1989
  • Gnanadev DA, Wang N, Communale FL, Reile DA. Carotid artery stump pressure: how reliable is it in predicting the need for a shunt?. Annals of Vascular Surgery 1989;3:313-7.
Godin 1989
Gomes 2010
Gumerlock 1988
Gurer 2003
  • Gurer O, Yapici F, Enc Y, Cinar B, Ketenci B, Ozler A. Local versus general anaesthesia for carotid endarterectomy: report of 329 cases. Vascular and Endovascular Surgery 2003;37:171-7.
Higgins 2003
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Javid 1979
  • Javid H, Julian OC, Dye WS, Hunter JA, Najafi H, Goldin MD, et al. Seventeen-year experience with routine shunting in carotid surgery. World Journal of Surgery 1979;3:167-77.
Kearse 1992
  • Kearse LA, Brown EN, McPeck K. Somatosensory evoked potential sensitivity relative to electroencephalography for cerebral ischemia during carotid endarterectomy. Stroke 1992;23:498-505.
Kresowik 1991
  • Kresowik TF, Worsey MJ, Khoury MD, Krain LS, Shamma AR, Sharp WJ, et al. Limitations of electroencephalographic monitoring in the detection of cerebral ischemia accompanying carotid endarterectomy. Journal of Vascular Surgery 1991;13:439-43.
Markowitz 1984
McCarthy 2001
  • McCarthy RJ, Walker R, McAteer P, Budd JS, Horrocks M. Patient and hospital benefits of local anaesthesia for carotid endarterectomy. European Journal of Vascular and Endovascular Surgery 2001;22:13-8.
Michenfelder 1975
  • Michenfelder JD, Milde JH. Cerebral protection by anesthetics during ischemia: (a review). Resuscitation 1975;4:219-33.
NASCET 1991
  • North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. New England Journal of Medicine 1991;325:445-53.
Ott 1980
Prioleau 1977
Reddy 1987
  • Reddy K, West M, Anderson B. Carotid endarterectomy without indwelling shunts and intraoperative electrophysiologic monitoring. Canadian Journal of Neurological Sciences 1987;14:131-5.
Rerkasem 2009
  • Rerkasem K, Rothwell PM. Temporal trends in the risks of stroke and death due to carotid endarterectomy for symptomatic carotid stenosis: an updated systematic review. European Journal of Vascular and Endovascular Surgery 2009;37:504-11.
Rerkasem 2010
  • Rerkasem K, Rothwell PM. Routine or selective carotid artery shunting for carotid endarterectomy and different methods of monitoring in selective shunting. Stroke 2010;41:e53-4.
Rerkasem 2011
RevMan 2012
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.2. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2012.
Ricotta 1983
Rothwell 1996
Rothwell 2003
  • Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003;361:107-16.
Schweiger 1988
  • Schweiger H, Kamp HD, Dinkel M. Somatosensory evoked potentials (SEP) during carotid endarterectomy - end of shunt debate?. In: Boccalon H editor(s). Angiology: strategy for diagnosis and therapeutics. Paris: John Libbey Eurotext, 1988:353-5.
Steiger 1989
  • Steiger HJ, Schaffler L, Boll J, Liechti S. Results of microsurgical carotid endarterectomy. A prospective study with transcranial Doppler and EEG monitoring, and elective shunting. Acta Neurochirurgica 1989;100:31-8.
Sundt 1986
  • Sundt TM Jr, Ebersold MJ, Sharbrough FW, Piepgras DG, Marsh WR, Messick JM Jr. The risk-benefit ratio of intraoperative shunting during carotid endarterectomy. Relevancy to operative and postoperative results and complications. Annals of Surgery 1986;203:196-204.
Thompson 1979
  • Thompson JE. Complications of carotid endarterectomy and their prevention. World Journal of Surgery 1979;3:155-65.
Weber 2009
  • Weber CF, Friedl H, Hueppe M, Hintereder G, Schmitz-Rixen T, Zwissler B, et al. Impact of general versus local anesthesia on early postoperative cognitive dysfunction following carotid endarterectomy: GALA study subgroup analysis. World Journal of Surgery 2009;33:1526-32.
Wells 1963

References to other published versions of this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. Additional references
  4. References to other published versions of this review
Rerkasem 2004
  • Rerkasem K, Bond R, Rothwell PM. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database of Systematic Reviews 2004, Issue 2. [DOI: 10.1002/14651858.CD000126]
Rerkasem 2008
Tangkanakul 1996
  • Tangkanakul C, Counsell C, Warlow C. Carotid endarterectomy performed under local anaesthetic compared to general anaesthetic: a systematic review of the evidence. Cochrane Database of Systematic Reviews 1996, Issue 3. [DOI: 10.1002/14651858.CD000126]