Affiliation:
1. City Clinical Hospital n.a. S. P. Botkin
2. City Clinical Hospital n.a. S. P. Botkin; Russian Medical Academy of Continuing Professional Education
Abstract
This article presents the Moscow Botkin Hospital experience of using combination of general and superficial cervical plexus regional anesthesia during carotid endarterectomy performed in patients in the acute period of atherothrombotic genesis ischemic stroke. The result of reliable antinociceptive protection of the body from the activation of the sympatho-adrenal system against the background of surgical manipulations was the prevention of episodes of critical hypertension and ensuring normalization of systemic hemodynamics. By reducing the need for opioids, patients’ awakening is accelerated, and their time in the operating room is minimized. In addition, the time of necessary observation in the intensive care unit and the need for anesthesia at the immediate postoperative period, is also reduced. The above factors, as well as a multidisciplinary approach to the patient, allowed not only to provide reliable prevention of recurrent vascular incidents in the acute period of ischemic stroke, but also to improve the neurological outcomes.
Reference40 articles.
1. Ischemic stroke and transient ischemic attack in adults [Electronic resource]. Rubricator of clinical recommendations. AllRussian Society of Neurologists, National Association against Stroke, Association of Neurosurgeons of Russia, Interregional public organization ‘Association of Neuroanesthesiologists and Neuroresuscitators’, AllRussian public organization ‘Union of Rehabil itologists of Russia’. 2021. URL: https://cr.minzdrav.gov.ru/recomend/171_2.
2. Orrapin S, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev. 2017 Jun 7; 6 (6): CD 001081. DOI: 10.1002/14651858.cd001081.pub3. Update in: Cochrane Database Syst Rev. 2020 Sep 12; 9: CD 001081. PMID: 28590505; PMCID: PMC 6481587.
3. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, LeslieMazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guide lines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association / American Stroke Association. Stroke. 2019 Dec; 50 (12): e344–e418.
4. Hill MD, Brooks W, Mackey A, et al. Stroke after ca rotid stenting and endarterectomy in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). Circulation 2012; 126: 3054–61.
5. Krul GM, van Gijn J, Ackerstaff RG, et al: Site and pathogenesis of infarcts associated with carotid endarterectomy. Stroke 20: 324–328, 1989.