[Surgery of the Carotid Artery: Locoregional Anesthesia Versus General Anesthesia: Review of the Literature]

The aim of the study was to compare locoregional and general anesthesia in carotid artery surgery in order to establish whether differences exist in terms of perioperative results, use of intraoperative shunts and costs. Seventeen studies, comprising 14,776 carotid endarterectomies performed with either locoregional or general anesthetic and published over the period from 1990 to March 2000, were reviewed. There were no statistically significant differences in the cardiovascular risk factors of the patients. Neurological morbidity and mortality were similar in the two groups, even if the use of shunts in the locoregional anesthesia group was lower than in the general anesthesia group and in four studies was associated with a significant difference (P < 0.01). No statistical differences in cardiac morbidity or mortality were found between the groups, except in two studies. Additional randomised prospective trials are needed in large numbers of patients. Locoregional anesthesia appears to allow a limited use of intraoperative shunts, but with neurological mortality and stroke rates very similar to those in the general anesthesia group. Routine use of locoregional anesthesia makes it possible to lower the cost of carotid surgery without sacrificing quality.