Patient and hospital benefits of local anaesthesia for carotid endarterectomy

Objectives: this study reviews and compares carotid endarterectomy (CEA) performed under local anaesthesia (LA) with CEA performed under general anaesthesia (GA) in a single institution. Methods: data were collected prospectively from 240 CEA procedures. 140GA CEA procedures are compared to 100 LA CEA procedures in terms of outcome, operative techniques, complications, and length of stay. Results: the groups were similar for age, gender distribution and preoperative risk factors. There were more asymptomatic patients in the LA group. There were no significant differences in death, stroke or death/stroke rate between the two techniques. LA CEA was associated with lower shunt rate (LA 13%, GA 50%, p<0.001), lower incidence of intraoperative hypotension (LA 8%, GA 40%, p<0.001), decreased hospital stay (median (IQ): LA 2(1-2), GA 3 (1-4) and a cost savings of pound 235 per CEA procedure. Conclusions: carotid endarterectomy can be performed safely under local anaesthesia with the advantage that LA CEA enables the surgeon to monitor and selectively shunt patients more accurately. In additions LA CEA is associated with a shorter hospital stay and important cost savings.