Outcomes for surgery to treat carotid (neck) artery blockages are the same for patients who have general or local anesthesia, according to a study by U.K. researchers.
Based on the findings, they say that doctors and patients should decide which type of anesthesia is most appropriate for them.
Blocked neck arteries increase the risk of stroke, and a procedure called carotid endarterectomy (CE) is used to clear the arteries. During CE, the carotid arteries are clamped, the inside of the arteries are exposed, and the plaque causing the blockage is removed. Blood flow to the brain is maintained through other blood vessels or an inserted shunt.
It had been believed that local anesthesia was safer than general anesthesia during these procedures, partly because surgeons could more easily check the patient's brain function in order to determine whether there was adequate blood flow.
The study included more than 3,500 patients treated at 95 centers in 24 countries. They were randomly assigned to receive general or local anesthesia, and the researchers examined primary events (rates of stroke, heart attack and death) among the patients until 30 days after surgery.
The two groups of patients had similar rates of primary events (4.8 percent for general anesthesia and 4.5 percent for local anesthesia) and didn't differ significantly in either length of hospital stay or quality of life. The findings were published online and in an upcoming print issue of The Lancet.
"In regard to major perioperative complications of stroke, heart attack, and death, there is no reason to prefer general over local anesthesia, of vice versa, as routine for carotid endarterectomy," wrote Dr. Michael Gough, of the vascular surgery department at Leeds General Infirmary, and colleagues.
"Similarly, we showed no definite evidence that the type of anesthesia affects length of hospital stay or quality of life," the researchers added. "Ideally, therefore, surgical and anesthetic teams should be competent in both techniques, because a patient might prefer, or there might be a medical reason, to choose one rather than the other," they said.
More information
The U.S. National Institute of Neurological Disorders and Stroke has more about carotid endarterectomy.
SOURCE: The Lancet, news release, Nov. 26, 2008
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