Perioperative management of carotid endarterectomy: A survey of clinicians' backgrounds and practices
Abstract
Objective To examine current trends in anesthetic practice for management of carotid
endarterectomy (CEA) and how practice may differ by groups of practitioners. Design
An online survey was sent to the Society of Cardiovascular Anesthesiologists and Society
of Neuroscience, Anesthesiology, and Critical Care e-mail list servers. Responses
were voluntary. Setting Academic medical centers and community-based hospitals providing
perioperative care for a CEA in the United States and abroad. Participants Anesthesiologists
who provide perioperative care for patients undergoing a CEA. Interventions None Measurements
and Main Results Of 664 responders (13% response rate), most (66%) had subspecialty
training in cardiovascular anesthesiology, had been in practice more than 10 years
(68%), and practiced in the United States (US, 81%). About 75% of responders considered
general anesthesia as a preferable technique for CA, and about 89% of responders provided
it in real life, independent of subspecialty training. The most preferable intraoperative
neuromonitoring was cerebral oximetry (28%), followed by EEG (24%), and having an
awake patient (23%). Neuroprotection was not considered by 33% of responders, and
upon conclusion of a case, 59% preferred an awake patient for extubation, while 15%
preferred a deep extubation. Neuroanesthesiologists and non-US responders more often
risk stratify patients for perioperative cerebral hyperperfusion syndrome, compared
with cardiac anesthesiologists and US responders (p = 0.004 and p<0.005, respectively).
Additionally, reported management strategies vary substantially from anesthetic practice
20 years ago. Conclusions Although there are areas of perioperative management in
which there seems to be agreement for the CEA, there are also areas of divergent practice
that could represent potential for improvement in overall outcomes. There are many
potential reasons to explain divergence in practice by location or subspecialty training,
but it remains unclear what the "best practice" may be. Future studies examining outcomes
after carotid endarterectomy should include perioperative anesthetic management strategies
to help delineate "best practice." © 2014 Elsevier Inc.
Type
Journal articlePermalink
https://hdl.handle.net/10161/9369Published Version (Please cite this version)
10.1053/j.jvca.2013.11.007Publication Info
Greene, Nathaniel H; Minhaj, Mohammed M; Zaky, Ahmed F; & Rozet, Irene (2014). Perioperative management of carotid endarterectomy: A survey of clinicians' backgrounds
and practices. Journal of Cardiothoracic and Vascular Anesthesia, 28(4). pp. 1002-1005. 10.1053/j.jvca.2013.11.007. Retrieved from https://hdl.handle.net/10161/9369.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Nathaniel Howard Greene
Assistant Professor of Anesthesiology

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