Is carotid endarterectomy under the cervical plexus block safe for all patients with various degree of cardiovascular risk?

• Published in: Bratislavské lékarské listy Vol. 112; no. 8; p. 453
• Main Authors: Mannova, J H, Silhart, Z, Prokes, A, Cupera, J
• Format: Journal Article
• Language: English
• Published: Slovakia 2011
• Subjects: Aged; Aged, 80 and over; Blood Pressure; Cardiovascular Diseases - etiology; Cervical Plexus; Endarterectomy, Carotid; Female; Heart Rate; Humans; Male; Middle Aged; Nerve Block; Postoperative Complications
• ISSN: 0006-9248

The result of the GALA study did not answer the question whether it is safe to perform carotid endarterectomy (CEA) under the cervical plexus block (CPB) in patients at high cardiovascular (CV) risk. The aim of the study was to compare CV stability and the frequency of cardiovascular and neurological complications in 3 groups of patients with various degree of CV risk who underwent CEA under CPB. 60 patients operated on in CPB were divided into the 3 groups according to the degree of their CV risk (I: very high, II: medium, III: low). Chi-square, Kruskal Wallis test. No statistically significant difference was confirmed in the changes of blood pressure (MAP, BP syst, BP diast), heart rate, cardiovascular complications, the rate of the shunt insertion and neurological complications and the level of haemodynamic instability, except for hypotension (p = 0.041) in the three groups. Life threatening CV complications did not occur in any of the groups. The frequency of haemodynamic changes and postoperative complications: hypertension (I--40%, II--60%, III--60%), hypotension (I--35%, II--25%, III--5%), arrhythmias (I--30%, II--15%, III--10%), neurological complications: 2x (TIA), the frequency of shunt insertion: 15 %. CPB can be performed in all three groups of patients, even in high-risk cardiac patients. The results will have to be confirmed in a larger group of patients in future (Tab. 3, Fig. 4, Ref. 16).