Key result
Anesthesia types and monitoring methods show no definitive superiority for carotid endarterectomy outcomes.
Why the study?
To systematically review the latest evidence on anesthesia, intraoperative neurologic monitoring, postoperative heparin reversal, and postoperative blood pressure management for carotid endarterectomy.
What is the optimal anesthetic management, neurologic monitoring, heparin reversal, and blood pressure management for patients undergoing carotid endarterectomy?
Systematic Review
What is the optimal anesthetic management, neurologic monitoring, heparin reversal, and blood pressure management for patients undergoing carotid endarterectomy?
This systematic review and guideline update suggests that while any anesthesia and monitoring method improves outcomes in carotid endarterectomy, evidence remains insufficient for routine heparin reversal.
Answers are grounded in this paper and cite their sources.
No single anesthesia or monitoring approach is superior for carotid endarterectomy; leaves open optimal heparin reversal and postoperative BP targets.
BACKGROUND AND AIMS: In order to systematically review the latest evidence on anesthesia, intraoperative neurologic monitoring, postoperative heparin reversal, and postoperative blood pressure management for carotid endarterectomy. The present review is based on a single chapter of the Italian Health Institute Guidelines for diagnosis and treatment of extracranial carotid stenosis and stroke prevention. METHODS AND RESULTS: A systematic article review focused on the previously cited topics published between January 2016 and October 2020 has been performed; we looked for both primary and secondary studies in the extensive archive of Medline/PubMed and Cochrane library databases. We selected 14 systematic reviews and meta-analyses, 13 randomized controlled trials, 8 observational studies, and 1 narrative review. Based on this analysis, syntheses of the available evidence were shared and recommendations were indicated complying with the GRADE-SIGN version methodology. CONCLUSIONS: From this up-to-date analysis, it has emerged that any type of anesthesia and neurological monitoring method is related to a better outcome after carotid endarterectomy. In addition, insufficient evidence was found to justify reversal or no-reversal of heparin at the end of surgery. Furthermore, despite a low evidence level, a suggestion for blood pressure monitoring in the postoperative period was formulated.
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Bevilacqua et al. (2022) conducted a systematic review in Carotid stenosis requiring carotid endarterectomy. Perioperative management strategies (anesthesia type, neurological monitoring, heparin reversal, blood pressure monitoring) vs. Alternative strategies or standard care was evaluated on Perioperative outcomes including stroke, myocardial infarction, death, and bleeding complications.
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