General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis

Objective: The choice of anesthetic technique in carotid endarterectomy (CEA) has been controversial. This study compared the outcomes of general anesthesia (GA) and local anesthesia (LA) in CEA. Design: Systematic review and meta-analysis of comparative studies. Setting: Hospitals. Participants: Adult patients undergoing CEA with either LA or GA. Interventions: The effects of GA and LA on CEA outcomes were compared. Measurements and Main Results: PubMed, OVID, Scopus, and Embase were searched to June 2018. Thirty-one studies with 152,376 patients were analyzed. A random effect model was used, and heterogeneity was assessed with the I2 and chi-square tests. LA was associated with shorter surgical time (weighted mean difference –9.15 min [–15.55 to –2.75]; p = 0.005) and less stroke (odds ratio [OR] 0.76 [0.62-0.92]; p = 0.006), cardiac complications (OR 0.59 [0.47-0.73]; p < 0.00001), and in-hospital mortality (OR 0.72 [0.59-0.90]; p = 0.003). Transient neurologic deficit rates were similar (OR 0.69 [0.46-1.04]; p = 0.07). Heterogeneity was significant for surgical time (I2 = 0.99, chi-square = 1,336.04; p < 0.00001), transient neurologic deficit (I2 = 0.41, chi-square = 28.81; p = 0.04), and cardiac complications (I2 = 0.42, chi-square = 43.32; p = 0.01) but not for stroke (I2 = 0.22, chi-square = 30.72; p = 0.16) and mortality (I2 = 0.00, chi-square = 21.69; p = 0.65). Randomized controlled trial subgroup analysis was performed, and all the aforementioned variables were not significantly different or heterogenous. Conclusion: The results from this study showed no inferiority of using LA to GA in patients undergoing CEA. Future investigations should be reported more systematically, preferably with randomization or propensity-matched analysis, and thus registries will facilitate investigation of this subject. Anesthetic choice in CEA should be individualized and encouraged where applicable. © 2019 Elsevier Inc.

Yazar Harky A.
Chan J.S.K.
Kot T.K.M.
Sanli D.
Rahimli R.
Belamaric Z.
Ng M.
Yayın Türü Review
Tek Biçim Adres https://hdl.handle.net/20.500.12628/5964
Tek Biçim Adres 10.1053/j.jvca.2019.03.029
Koleksiyonlar Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed | SOBİAD
Scopus İndeksli Yayınlar Koleksiyonu
Sayfalar 219 - 234
Yayın Yılı 2020
Eser Adı
[dc.title]
General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis
Yayın Yılı
[dc.date.issued]
2020
Yayıncı
[dc.publisher]
W.B. Saunders
Yayın Türü
[dc.type]
review
Özet
[dc.description.abstract]
Objective: The choice of anesthetic technique in carotid endarterectomy (CEA) has been controversial. This study compared the outcomes of general anesthesia (GA) and local anesthesia (LA) in CEA. Design: Systematic review and meta-analysis of comparative studies. Setting: Hospitals. Participants: Adult patients undergoing CEA with either LA or GA. Interventions: The effects of GA and LA on CEA outcomes were compared. Measurements and Main Results: PubMed, OVID, Scopus, and Embase were searched to June 2018. Thirty-one studies with 152,376 patients were analyzed. A random effect model was used, and heterogeneity was assessed with the I2 and chi-square tests. LA was associated with shorter surgical time (weighted mean difference –9.15 min [–15.55 to –2.75]; p = 0.005) and less stroke (odds ratio [OR] 0.76 [0.62-0.92]; p = 0.006), cardiac complications (OR 0.59 [0.47-0.73]; p < 0.00001), and in-hospital mortality (OR 0.72 [0.59-0.90]; p = 0.003). Transient neurologic deficit rates were similar (OR 0.69 [0.46-1.04]; p = 0.07). Heterogeneity was significant for surgical time (I2 = 0.99, chi-square = 1,336.04; p < 0.00001), transient neurologic deficit (I2 = 0.41, chi-square = 28.81; p = 0.04), and cardiac complications (I2 = 0.42, chi-square = 43.32; p = 0.01) but not for stroke (I2 = 0.22, chi-square = 30.72; p = 0.16) and mortality (I2 = 0.00, chi-square = 21.69; p = 0.65). Randomized controlled trial subgroup analysis was performed, and all the aforementioned variables were not significantly different or heterogenous. Conclusion: The results from this study showed no inferiority of using LA to GA in patients undergoing CEA. Future investigations should be reported more systematically, preferably with randomization or propensity-matched analysis, and thus registries will facilitate investigation of this subject. Anesthetic choice in CEA should be individualized and encouraged where applicable. © 2019 Elsevier Inc.
Tek Biçim Adres
[dc.identifier.uri]
https://dx.doi.org/10.1053/j.jvca.2019.03.029
Tek Biçim Adres
[dc.identifier.uri]
https://hdl.handle.net/20.500.12628/5964
Yayın Dili
[dc.language.iso]
eng
Yazar
[dc.contributor.author]
Harky A.
Yazar
[dc.contributor.author]
Chan J.S.K.
Yazar
[dc.contributor.author]
Kot T.K.M.
Yazar
[dc.contributor.author]
Sanli D.
Yazar
[dc.contributor.author]
Rahimli R.
Yazar
[dc.contributor.author]
Belamaric Z.
Yazar
[dc.contributor.author]
Ng M.
Haklar
[dc.rights]
info:eu-repo/semantics/closedAccess
İlk Sayfa Sayısı
[dc.identifier.startpage]
219
Son Sayfa Sayısı
[dc.identifier.endpage]
234
Açık Erişim Tarihi
[dc.date.available]
2019-12-23
Görüntülenme Sayısı ( Şehir )
Görüntülenme Sayısı ( Ülke )
Görüntülenme Sayısı ( Zaman Dağılımı )
Görüntülenme
8
09.12.2022 tarihinden bu yana
İndirme
1
09.12.2022 tarihinden bu yana
Son Erişim Tarihi
06 Şubat 2024 05:50
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chi-square patients analysis neurologic mortality cardiac surgical 00001) complications stroke should deficit undergoing compared outcomes studies anesthesia choice subject transient Anesthetic similar Elsevier individualized applicable encouraged Heterogeneity significant investigation showed different preferably heterogenous Conclusion results
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