Perioperative stress response to carotid endarterectomy - the impact of anesthetic modality. Own experience

Abstract

Background. Carotid endarterectomy (CE) belongs to the group of exceptional operations with the possibility of intra and perioperative complications that can account for the life or well being of the patient. For this reason it requires the application of anaesthetic techniques that assure optimal conditions for blood flow and proper perfusion of the brain and enable immediate detection of brain ischemia. These conditions are fulfilled by regional anaesthesia. In accessible literature we were not able to find any comparison of exacerbation of perioperative stress depending on anaesthetic modality during CE. The aim of the study was to evaluate our patients towards exacerbation of perioperative stress depending on anaesthetic modality during CE.
Material and methods. 19 patients underwent carotid artery endarterectomy. They were divided into 2 groups. Group A consisted of 10 patients operated on under epidural anaesthesia (EA). Group B - 9 patients operated on under cervical plexus blockade (CPB). The levels of cortisone (C), adrenocorticotropic hormone (ACTH) and prolactin (PR) during 6 different phases of intra- and perioperative periods were measured.
Results. Levels of C during the whole study remained normal or somewhat elevated in both groups. Levels of ACTH and PR demonstrated a similar pattern of changes. Before the operation they were within normal range or slightly elevated. During CE the levels of both hormones rose in both groups especially after carotid artery cross-clamping, but they were much higher in group B. After 2 hours ACTH and PR returned to normal and remained that way until the end of observation. Because the groups were small in number, no statistically significant changes were observed.
Conclusions. Exacerbation of perioperative stress measured by hypercortisolaemia is well correlated with brain hypoperfusion during CE. 2 hours after the operation the influence of anaesthetic modality on perioperative stress terminates. In our study the perioperative stress relating to CE performed under epidural anaesthesia and under cervical plexus blockade was not significantly different.