Armando Mansilha*
* Professor Auxiliar Convidado da Faculdade de Medicina do Porto Assistente Hospitalar de Angiologia e Cirurgia Vascular no Hospital de São João Coordenador da Unidade de Angiologia e Cirurgia Vascular do Hospital CUF Porto
|RESUMO|
A eficácia da endarterectomia carotídea (CEA) na prevenção do acidente vascular cerebral (AVC) em doentes com estenose carotídea sintomática e assintomática foi estabelecida em vários estudos randomizados multicêntricos.
A anestesia local tem sido associada a um potencial benefício comparativamente à anestesia geral, em termos de diminuição da morbilidade neurológica e mortalidade, bem como redução de custos hospitalares.
Este artigo procura analisar e discutir os resultados publicados, particularmente a mais recente meta-análise da Cochrane e o estudo GALA, o maior estudo randomizado cirúrgico/anestésico alguma vez efectuado nesta área.
São também referidas as recomendações publicadas pela European Society for Vascular Surgery (ESVS) bem como os resultados de uma experiência pessoal.
]]> Palavras-chave: Estenose carotídea, endarterectomia, anestesia loco-regional, anestesia geral
Carotid Endarterectomy under Local Anaesthesia
|ABSTRACT|
The efficacy of carotid endarterectomy (CEA) in preventing the stroke in patients with symptomatic and asymptomatic carotid stenosis has been established in different multicentre randomised controlled trials.
CEA under local anaesthesia versus general anaesthesia has been associated with potential benefits concerning reduction in the odds of stroke, death and hospital costs.
This review will analyse the published results, particularly those from last Cochrane meta-analysis and from GALA trial, the largest randomised surgical/anaesthetic trial ever performed in this field.
It will be also analysed the recommendations published by the European Society for Vascular Surgery (ESVS) and the singular results from a personal experience.
Key words: Carotid stenosis, endarterectomy, local anaesthesia, general anaethesia
]]>Texto completo disponível apenas em PDF.
Full text only available in PDF format.
BIBLIOGRAFIA
[1] Tangkanakul C, Counsell CP, Warlow CP. Local versus general anaesthesis in carotid endarterectomy: a systematic review of the evidence. Eur J Vasc Endovasc Surg 1997; 13: 491-499. [ Links ]
[2] Campkin TV, Turner JM. Anaesthesia for the surgery of cerebral arterial insufficiency. In: campkin TV, Turner JM (eds) Neurosurgical anaesthesia and intensive care, pp. 222-236. London: Butterworths, 1986.
[3] Hobson RW, Wright CB, Sublett JW, Fedde W, Rich NM. Carotid artery back pressure and endarterectomy under regional anaesthesia. Archives of Surgery 1974; 109: 680-687. [ Links ]
[4] Benjamin ME, Silva MB, Watt C, et al. Awake patient monitoring to determine the need for shunting during carotid endarterectomy. Surgery 1993; 114: 673-679. [ Links ]
[5] Luosto R, Ketonon P, Mattila S, takkunem O, Eerola S. Local anaesthesia in carotid surgery. Scandinavian Journal of Thoracic and Cardiovascular Surgery 1984; 18: 133-137. [ Links ]
[6] Halsey JH. Risks and benefits of shunting in carotid endarterectomy. Stroke 1992; 23: 1583-1587. [ Links ]
[7] Allen BT, Anderson CB, Rubin BG, et al. The influence of anesthetic technique on perioperative complications after carotid endarterectomy. J Vasc Surg 1994; 19: 834-843. [ Links ]
[8] Becquemin JP, Paris E, Valverde A, Pluskwa F, Melliere D. Carotid surgery: is regional anesthesia always appropriate? J Cardiovasc Surg 1991; 32: 592-598. [ Links ]
[9] Shah DM, Darling RC III, Chang BB, Bock DEM, Paty PSK, Leather RP. Carotid endarterectomy in awake patients: its safety, acceptability and outcome. J Vasc Surg 1994; 19: 1015-1021.
[10] Rockman CB, Riles TS, Gold M, et al. A comparison of regional and general anesthesia in patients undergoing carotid endarterectomy. J Vasc Surg 1996; 24: 946-956.
[11] McCarthy RJ, Nasr MK, McAteer P, Horrocks M. Physiological advantages of cerebral blood flow during carotid endarterectomy under local anaesthesia. A randomised clinical trial. Eur J Vasc Endovasc Surg 2002; 24: 215-221.
[12] Sternbach Y, Illig KA, Renyu Zhang BS, et al. Hemodynamic benefits of regional anesthesia for carotid endarterectomy. J Vasc Surg 2002; 35: 333-338.
[13] McCarthy RJ, Walker P, McAteer P, Budd JS, Horrocks M. Patient and hospital benefits of local anaesthesia for carotid endarterectomy. Eur J Vasc Endovasc Surg 2001; 22: 13-18.
[14] Rerkasem K, Bond R, Rothwell PM. Local versus general anaesthesia for carotid endarterectomy. Cochrane Database of Syst Rev 2004; 2: CD000126.
[15] GALA trial collaborative group. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. Lancet 2008; 372: 2132-42.
]]> [16] Gomes M, Soares MO, Dumville JC, Lewis SC, Torgerson DJ, Bodenham AR, Gough MJ, Warlow CP; GALA Collaborative Group. Cost-effectiveness analysis of general anaesthesia versus local anaesthesia for carotid surgery (GALA Trial). Br J Surg. 2010; 97(8):1218-25.[17] Liapis CD, Bell PF, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, et al, on behalf of the Guidelines Collaborators. ESVS Guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur J Vasc Endovasc Surg 2009; 37: 1-19.
]]>