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Review of 'Carotid Endarterectomy with Local Anesthesia and LMA/General Anesthesia'

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Well-written, easy to understand paper for clinically significant procedure and tech.
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Carotid Endarterectomy with Local Anesthesia and LMA/General Anesthesia

 Hani Annabi,  Charles Fleischer,  Robert Taylor (corresponding) (2014)
There is no clear consensus as to the appropriate anesthetic technique for patients undergoing a carotid endarterectomy. Such patients may have comorbid conditions, such as coronary artery disease, hyperlipidemia, and others. The two main anesthetic approaches are general anesthesia, including an endotracheal tube, with neurological monitoring and regional anesthesia that allows for an awake patient to be assessed neurologically. The objective of our study was to evaluate a novel anesthetic technique that combined general anesthesia with a laryngeal mask airway (LMA) plus regional anesthesia in the form of bupivacaine injected into the surgical site. Anesthesia was maintained with desflurane 4%, so the patient emerged rapidly for neurological assessment at the conclusion of surgery. We report on a case of a 55-year-old patient who underwent a successful carotid endarterectomy using this hybrid technique of general anesthesia with LMA plus regional anesthesia. This technique was safe and effective and the patient experienced no complications other than a hematoma on the left neck that was likely the result of long-term use of aspirin and Plavix. While further study is warranted, this hybrid technique of general anesthesia with LMA plus regional anesthesia holds promise for carotid endarterectomy patients.
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    Review information

    10.14293/S2199-1006.1.SOR-MED.ATXB4F.v1.RJOAWJ

    This work has been published open access under Creative Commons Attribution License CC BY 4.0, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Conditions, terms of use and publishing policy can be found at www.scienceopen.com.

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    Review text

    The authors studied the feasibility of replacing GA/endotracheal intubation with laryngeal mask+regional anesthesia in cases of carotid endarterectomy, which are usually performed in patients with various comorbidities. Despite only one case presentation, the authors gave new insights into adopting less invasive anesthetic technique whenever possible.

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