The Influence of Anesthetic Technique on Perioperative Blood Pressure Control after Carotid Endarterectomy

Abstract

The optimal anesthetic for use during carotid endarterectomy has been a matter of debate for three decades. The goal of this study is to evaluate the influence of anesthetic technique on perioperative hemodynamic instability after carotid endarterectomy. This study is a retrospective chart review and was performed in a community teaching hospital. All consecutive patients undergoing carotid endarterectomy over a 2-year period at Providence Hospital were reviewed. One hundred ninety-eight patients underwent 203 carotid endarterectomies. Two patients were excluded because of combined coronary artery bypass grafting. Patients underwent carotid endarterectomy and were divided into two groups on the basis of use of general or regional anesthesia. Blood pressure was recorded hourly for the subsequent 24 hours, and the doses of vasoactive medications received to maintain the blood pressure within 25 mm Hg of preoperative levels were recorded. Patients receiving general anesthesia were found to require significantly more sodium nitroprusside for control of hypertension compared with those receiving regional anesthesia (72.1 ± 14.5 μg/kg vs 20.2 ± 6.6 ug/kg; P = 0.001) in the first 8 postoperative hours. No significant differences were noted in the doses of any other vasoactive medications used. No differences were found in the subsequent 16-hour period in doses of vasoactive medications. Patients suffering myocardial infarctions were found to receive higher doses of nitroglycerine, but no differences were noted in any other vasoactive medication used based on complications. Length of stay was longer in the general anesthesia group compared with the regional anesthesia group for both the intensive care unit (1.59 ± 0.13 days vs 1.08 ± 0.03 days; P = 0.001) and total hospital stay (5.8 ± 0.03 days vs 4.5 ± 0.02 days; P = 0.003). Regional anesthesia required lower doses of antihypertensive medication in the early postoperative period when compared with general anesthesia. The doses of vasoactive medications used had no significant impact on the complication rate. Regional anesthesia allowed for shorter stay in both the intensive care unit and total hospital stay.