• J. Cardiothorac. Vasc. Anesth. · Feb 2007

    Meta Analysis Comparative Study

    Regional or general anesthesia for carotid endarterectomy? Evidence from published prospective and retrospective studies.

    • Joanne Guay.
    • Department of Anesthesia, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, Quebec, Canada. joanne.guay@umontreal.ca
    • J. Cardiothorac. Vasc. Anesth. 2007 Feb 1;21(1):127-32.

    ObjectivesThe aim of this study was to compare outcomes of patients undergoing carotid endarterectomy under regional or general anesthesia for any new neurologic impairment, stroke, stroke and/or death, death, and myocardial infarction.DesignMeta-analysis.SettingA search of the National Library of Medicine of the United States PUBMED from 1966 up to June 11, 2005, with the following key words: "carotid surgery or endarterectomy and regional anesthesia."Measurements And Main ResultsForty-eight studies (14 prospective and 34 retrospective) were analyzed. The optimal information size was achieved only when all studies were analyzed together (prospective and retrospective). Regional anesthesia reduced the rate of any new neurologic impairment (odds ratio = 0.60; 95% confidence interval, 0.48-0.75; p < 0.00001), stroke (0.54 [0.43-0.68], p < 0.00001), stroke and/or death (0.62 [0.49-0.78], p < 0.0001), death (0.65 [0.48-0.87], p = 0.004), and myocardial infarction (0.50 [0.36-0.70], p < 0.0001).ConclusionThe number of patients included in randomized controlled trials or even in prospective studies is too low to allow any conclusions on the differences in outcome between the 2 anesthetic techniques. Better outcomes are suggested when results from retrospective studies are added.

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