CEA Anesthesia or Carotid endarterectomy anesthesia can be general or regional or combined. Here is a discussion on the relative advantages and disadvantageous of the different types.
Mc CaI Thyet al conducted a prospective, randomized trial investigating patient experience of CEA Anesthesia under local or general anesthesia in 176 patients and found that the recovery score was significantly better in the group that received local anesthesia including perception of factors such as postoperative nausea, pain and length of stay.
The main disadvantage of regional anesthesia is the unpleasant operative experience for the patient, especially if the operation is of long duration.
There were no differences in scores of anxiety, satisfaction or information during the use of CEA Anesthesia . A large majority of each group agreed that they would choose the same type of anaesthetic if given a choice for a second hypothetical operation. Thus, the results do not support some of the purported disadvantages of local anaesthesia including heightened anxiety, low tolerance and low acceptability by patients.
A systematic review identified seven randomized trials comparing CEA Anesthesia under local versus general anaesthesia wherein the meta-analysis showed a significant reduction ,in local haemorrhage, but no evidence of a reduction in the risk of operative stroke in the group of patients who had surgery under local anesthesia. However, it was concluded that the trials were too small to draw a reliable conclusion and the large number of non-randomised trials which may be biased, suggest potential benefits with the use of local CEA Anesthesia .
The management of wide swings in blood pressure encountered during CEA Anesthesia varies widely. Transient surgically induced dysfunction of carotid baroreceptors was considered to be the cause for this haemodynamic instability traditionally, and hence local anaesthetic injection around the baroreceptor may be effective in controlling the blood pressure changes. Elliott et al in a randomized controlled study failed to demonstrate the efficacy of CEA Anesthesia technique.
Apart from this, clinicians have attempted to control the blood pressure by changing the CEA Anesthesia drug levels or with vasoactive agents such as phenylephrine, ephedrine, esmolol, nitroprusside or nitroglycerine.
Smith et al preferred to control the haemodynamics by adjusting the anaesthetic agent concentration as it results in lower incidence of ventricular wall motion abnormalities suggestive of myocardial ischaemia whereas use of phenylephrine was associated with a greater incidence and severity of wall motion abnormalities. However, frequent adjustments of anaesthetic agent and CEA Anesthesia may be associated with EEG changes that could increase the difficulty associated with the interpretation of the EEG.