Anaesthetic Monitoring of Patients during Carotid Endarterectomy

Atherosclerotic lesions of the extracranial arteries, namely the proximal portion of the internal carotid artery (ICA) are the leading cause of cerebral ischemia. Thus, surgical prevention of ischemic stroke consists in carotid endarterectomy. Considering polymorbidity in patients with atherosclerosis an anaesthetic monitoring of patients during arterial reconstruction is of great importance. The objective of the research was to analyze the methods of intraoperative monitoring and the type of anaesthesia during carotid endarterectomy and to study their impact on the results of surgical treatment. Materials and methods. The results of carotid endarterectomy performed in 415 patients with atherosclerotic lesions of carotid arteries were analyzed. All patients underwent carotid endarterectomy under general anaesthesia. The control of cerebral blood flow was made measuring oxygen saturation with the use of INVOS 5100 (Somanetics Corp., USA). All patients were divided into 3 groups: Group I included 102 patients being at risk of developing somatic diseases, Group II included 239 patients being at risk of developing neurological and symptomatic conditions, and Group III comprised 74 patients with neurologic impairment being at risk of developing somatic diseases. The traditional carotid endarterectomy and eversion carotid endarterectomy were performed. Results and discussion. Due to intraoperative cerebral oximetry in 56 (13.5%) patients when compressing the common carotid artery (CCA) oxygen saturation levels were found to be decreased by 25-30%. In these patients, carotid endarterectomy was performed using an intraoperative shunt. Among patients of Group I perioperative complications were not observed. The level of perioperative ischemic complications in Group II was 2.1% while in Group III it was 4.1%. The overall mortality/complication rate was 3.9% (4.2% in Group II and 5.4% in Group III). The overall perioperative mortality rate was 1.2%. Conclusions. General anaesthesia during carotid endarterectomy with intraoperative measurement of transcranial cerebral oxygen saturation allows us to achieve good perioperative results (the overall mortality/complication rate is 3.9%).