Patients' Views on Regional Anesthesia for Elective Unilateral Carotid Endarterectomy-A Prospective Cohort Study

Background: Carotid endarterectomy (CEA) can be performed under general anesthesia (GA) or locoregional anesthesia (LA). However, the patients' views on the choice between GA and LA are currently poorly understood. We aimed at identifying the preoperative patient information needs, their role in decision-making, and influencing factors associated with LA and anxiety regarding surgery and anesthesia in CEA as a base for improving preoperative consultation and decision-making in the informed consent process. Methods: Data were collected from consecutive patients undergoing unilateral elective CEA. Data on basic demographics, preoperative information needs, factors influencing decision-making concerning anesthesia technique, a Mini Mental State Examination (MMSE), a Visual Analog Scale (VAS), and the State-Trait Anxiety Inventory (STAI-T/S) were collected. Results: A total of 59 patients were included in the study, 10 women and 49 men, with a median age of 71 years (interquartile range, 66-77 years). Fifty-four (92%) patients assessed the surgeons' given information as adequate. Older patients (> 70 years, n = 31) had less self-conception of anxiety compared to younger patients (<= 70 years, n = 28), 3% vs. 21%, P = 0.045. Males expressed less anxiety regarding "waking up during general anesthesia" compared to females (0% vs. 30%, P < 0.001). Anxiety about anesthesia and surgery as measured by VAS highly correlated with the STAI-S scores (Pearson correlation coefficient [CC], 0.45; 95% confidence interval [CI], 0.18-0.66, P < 0.001; CC, 0.47; 95% CI, 0.27-0.66, P < 0.001, respectively). Patients with a lower cognitive function (MMSE <= 27, n = 20) had lower needs for preoperative medical information compared to patients with MMSE > 27 (n = 36), 0% vs. 15%, P = 0.042. Two (3%) patients received GA because of their previous bad experience with LA. Conclusions: Younger and female patients may benefit from a more detailed and reassuring informed consent process. All institutions should use procedure-specific informed consent forms as they appear to be very adequate for the patient information needs. Nearly all patients are willing to undergo LA with the exception of those having had previous bad experience with LA for CEA.