Anesthetic management of carotid endarterectomy: an update from Italian guidelines

被引：5

作者：

Bevilacqua, Sergio ^{[1
]}

Ticozzelli, Giulia ^{[2
]}

Orso, Massimiliano ^{[3
]}

Alba, Giuseppe ^{[4
]}

Capoccia, Laura ^{[5
]}

Cappelli, Alessandro ^{[6
]}

Cernetti, Carlo ^{[7
]}

Diomedi, Marina ^{[8
]}

Dorigo, Walter ^{[9
]}

Faggioli, Gianluca ^{[10
]}

Giannace, Giovanni ^{[11
]}

Giannandrea, David ^{[12
]}

Giannetta, Matteo ^{[13
]}

Lessiani, Gianfranco ^{[14
]}

Marone, Enrico Maria ^{[15
,16
]}

Mazzaccaro, Daniela ^{[13
]}

Migliacci, Rino ^{[17
]}

Nano, Giovanni ^{[13
]}

Pagliariccio, Gabriele ^{[18
]}

Petruzzellis, Marco ^{[19
]}

Plutino, Andrea ^{[20
]}

Pomatto, Sara ^{[10
]}

Pulli, Raffaele ^{[21
]}

Sirignano, Pasqualino ^{[22
]}

Vacirca, Andrea ^{[23
]}

Visco, Emanuele ^{[24
]}

Moghadam, Shadeh Parsapour ^{[25
]}

Lanza, Gaetano ^{[26
]}

Lanza, Jessica ^{[27
]}

机构：

[1] Azienda Osped Univ Careggi, Dept Anesthesia, Florence, Italy

[2] Fdn IRCCS Policlin San Matteo, Anesthesiol & Intens Care Unit, Pavia, Italy

[3] Soc Italiana Chirurg Vasc & Endovasc SICVE, Rome, Italy

[4] Univ Siena, Dept Vasc Surg, Siena, Italy

[5] Sapienza Univ Rome, Policlin Umberto I, Vasc & Endovasc Surg Div, Rome, Italy

[6] Univ Siena, Policlin Le Scotte Hosp, Vasc Surg Unit, Siena, Italy

[7] Azienda USLL2 Marca Trevigiana, Ca Foncello Hosp, Div Cardiol & Intervent Hemodynam, Treviso, Italy

[8] Tor Vergata Univ Hosp, Dept Syst Med, Stroke Unit, Rome, Italy

[9] Univ Florence, Vasc Surg Unit, Florence, Italy

[10] Alma Mater Studiorum Univ, Policlin St Orsola, Vasc Surg Unit, Bologna, Italy

[11] Arcispedale Snata Maria Nuova, Vasc Surg Unit, Reggio Emilia, Italy

[12] USL Umbria 1, Neurol Dept, Stroke Unit, Perugia, Italy

[13] IRCCS Policlin San Donato Hosp Univ, Vasc Surg Unit, San Donato Milanese, Italy

[14] AUSL 3, Villa Serena Hosp, Angiol Unit, Pescara, Italy

[15] Dept Policlin Monaza, Vasc Surg Unit, Monza, Italy

[16] Pavia Univ, Pavia, Italy

[17] Valdichiana S Margher Hosp, Angiol & Internal Med, Cortona, Italy

[18] Policlin Riuniti Hosp Univ, Vasc Surg Unit, Ancona, Italy

[19] Policlin Hosp Univ, Neurol & Stroke Unit, Bari, Italy

[20] Marche Nord Riuniti Hosp, Stroke Unit, Fano, Italy

[21] Policlin Careggi Hosp Univ, Vasc Surg Unit, Florence, Italy

[22] Univ Roma La Sapienza, St Andrea Hosp, Vasc & Endovasc Surg Div, Rome, Italy

[23] Alma Mater Studiorum Univ, Policlin San Orsola, Vasc Surg Unit, Bologna, Italy

[24] Azienda ULSS2 Marca Trevigiana, San Giacomo Apostolo Hosp, Div Cardiol & Intervent Hemodynam, Castelfranco Veneto, Italy

[25] Northwick Pk Hosp & Clin Res Ctr, London, England

[26] Multimed Hosp IRCCS, Vasc Surg Dept, Castellanza, Italy

[27] IRCSS Osped Policlin, Vasc Surg Dept, San Martino Genova, Italy

来源：

JOURNAL OF ANESTHESIA ANALGESIA AND CRITICAL CARE | 2022年 / 2卷 / 01期

关键词：

Carotid endarterectomy; Anesthesia; Intraoperative cerebral monitoring; Heparin reversal; Blood pressure monitoring; Guidelines; Recommendations; GENERAL-ANESTHESIA; DIAGNOSTIC-ACCURACY; CEREBRAL-ISCHEMIA; REGIONAL ANESTHESIA; LOCAL-ANESTHESIA; EEG CHANGES; PATIENT; ELECTROENCEPHALOGRAPHY; HYPERTENSION; STROKE;

D O I：

10.1186/s44158-022-00052-9

中图分类号：

R614 [麻醉学];

学科分类号：

100217 ;

摘要：

Background and aimsIn order to systematically review the latest evidence on anesthesia, intraoperative neurologic monitoring, postoperative heparin reversal, and postoperative blood pressure management for carotid endarterectomy. The present review is based on a single chapter of the Italian Health Institute Guidelines for diagnosis and treatment of extracranial carotid stenosis and stroke prevention.Methods and resultsA systematic article review focused on the previously cited topics published between January 2016 and October 2020 has been performed; we looked for both primary and secondary studies in the extensive archive of Medline/PubMed and Cochrane library databases.We selected 14 systematic reviews and meta-analyses, 13 randomized controlled trials, 8 observational studies, and 1 narrative review. Based on this analysis, syntheses of the available evidence were shared and recommendations were indicated complying with the GRADE-SIGN version methodology.Methods and resultsA systematic article review focused on the previously cited topics published between January 2016 and October 2020 has been performed; we looked for both primary and secondary studies in the extensive archive of Medline/PubMed and Cochrane library databases.We selected 14 systematic reviews and meta-analyses, 13 randomized controlled trials, 8 observational studies, and 1 narrative review. Based on this analysis, syntheses of the available evidence were shared and recommendations were indicated complying with the GRADE-SIGN version methodology.ConclusionsFrom this up-to-date analysis, it has emerged that any type of anesthesia and neurological monitoring method is related to a better outcome after carotid endarterectomy. In addition, insufficient evidence was found to justify reversal or no-reversal of heparin at the end of surgery. Furthermore, despite a low evidence level, a suggestion for blood pressure monitoring in the postoperative period was formulated.

引用

页数：12

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