Cervical epidural anaesthesia for surgery of the carotid artery Karotis ameliyatlarinda servikal epidural anestezi
Turk Anesteziyoloji ve Reanimasyon, cilt.28, sa.7, ss.339-344, 2000 (Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 28 Sayı: 7
- Basım Tarihi: 2000
- Dergi Adı: Turk Anesteziyoloji ve Reanimasyon
- Derginin Tarandığı İndeksler: Scopus
- Sayfa Sayıları: ss.339-344
- Anahtar Kelimeler: Carotid endarterectomy, Cervical epidural anaesthesia
- Acıbadem Mehmet Ali Aydınlar Üniversitesi Adresli: Evet
Özet
In our study cervical epidural anaesthesia (CEA) using the combination of the lidocaine- fentanyl has been studied. After exclusion of contraindications for CEA or dysartria, 35 consenting patients submitted to carotid artery surgery (CAS) were studied. In all patients an epidural catheter was inserted under fluoroscopic control through the C7-T1. After a test dose of 2 mL of 1 % lidocaine a 20 mL solution consisted of 12 mL lidocaine % 2, fentanyl 2 mL and saline 6 mL was injected in two times 4 mL's within 4 min. and then in 2 mL portions, if required. Hemodynamic (ECG, SpO2 and invasive blood pressure (IBP)) and neurologic (consciousness and motor function of the contralateral hand) functions were monitored from the beginning of the procedure and perioperatively. Respiration was monitored with PaCO2 values pre- and peroperatively. In all patients a sensory blockade between C2 and T(6±2) was obtained with a dosis of 11.4±2.5 mL in 20 min. Hypotension observed in 3 patients and bradycardia in 1 patient. In 3 patients it has been possible to operate without an arterial shunt although it was necessary according to the surgical protocol (stump pressure (SP) <55 mm Hg). In another patient with SP <55 mm Hg a transient ischaemic attack occurred after the carotid artery was clamped, which disappeared after the rapid insertion of the arterial shunt without any neurologic sequela. There was a statistically significant, but clinically irrelevant increase in PaCO2 after the block (39.1±5.7 mm Hg before vs. 43.1±5.5 mm Hg after the block). It appears that this technique can be preferred in CAS because of haemodynamic stability and reliable neurologic monitoring.