New Anesthesia Technique Lets Patients Cooperate During Carotid Surgery

Main Category: Pain / Anesthetics
Article Date: 06 Jun 2009 - 1:00 PDT

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Can a patient be awake and communicating with the anesthesiologist and surgeon during general anesthesia? With a new "cooperative patient" anesthesia technique, the answer is yes, according to a study in the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

An Italian research team, led by Dr. Sergio Bevilacqua of Ospedaliera Universitaria Careggi, Florence, report on the use of their "cooperative patient general anesthesia" technique in 181 patients undergoing carotid artery surgery (endarterectomy) for stroke prevention. The patients received conventional general anesthesia up to the time that the carotid artery was clamped, as must be done so that the surgeon can repair it.

At that time, the general anesthetic was reduced, and the patients received an infusion of remifentanil a morphine-like drug that suppresses pain but permits the patient to regain consciousness. During this part of the procedure, the patients were able to respond to simple commands, such as to open their eyes or squeeze a toy in their hand. This permitted the surgeon to verify that the blood supply to the brain remained adequate during surgery.

Communication Allows Monitoring of Brain Blood Supply During Surgery

The cooperative technique was successfully carried out in all but two patients, who were kept on general anesthesia. All of the remaining patients were able to respond to the surgeon's commands. In about twelve percent of cases, the responses from the conscious patient led the surgeon to take additional steps to protect the brain blood flow.

Most patients reported no problems with related to being conscious during their surgery. Ninety-nine percent of patients found the experience nonstressful sometimes even pleasant. Most described the experience as dreamlike; although some had more vivid recollections, none reported any pain or distress. Both patients and surgeons were happy with the anesthesia technique.

Carotid endarterectomy is a common procedure to prevent stroke in patients with atherosclerosis ("hardening") of the carotid arteries supplying blood to the brain. Local anesthesia can be used, leaving the patient conscious for monitoring during the procedure. This allows the surgical team to monitor the patient's condition during surgery. However, many patients and surgeons are uncomfortable with this technique.

The new study finds cooperative patient general anesthesia to be a "safe and satisfactory" technique for use in carotid surgery. By allowing the patient to respond to simple commands, it provides the surgeon with valuable information to guide the procedure. The procedure appears safe, pain free, and not disturbing or traumatic for the patient, the researchers write.

About the IARS

The International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to encourage, stimulate, and fund ongoing anesthesia-related research and projects that will enhance and advance the anesthesiology specialty. The IARS has a worldwide membership of 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia-related practice. In additional to publishing the monthly scientific journal Anesthesia & Analgesia, the IARS sponsors an annual clinical and scientific meeting, funds anesthesia-related research, and sponsors the Global Perioperative Research Organization (GPRO).

Source IARS