Anesthetic management of carotid endarterectomy: an update from Italian guidelines.

Autor: Bevilacqua S; Department of Anesthesia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy., Ticozzelli G; Anesthesiology and Intensive Care Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy. g.ticozzelli@smatteo.pv.it., Orso M; Società Italiana di Chirurgia Vascolare ed Endovascolare (SICVE), Roma, Italy., Alba G; Department of Vascular Surgery, University of Siena, Siena, Italy., Capoccia L; Vascular and Endovascular Surgery Division, Policlinico Umberto I La Sapienza University of Rome, Rome, Italy., Cappelli A; Vascular Surgery Unit, Policlinico Le Scotte Hospital University of Siena, Siena, Italy., Cernetti C; Division of Cardiology and and Interventional Hemodynamics, Ca' Foncello Hospital, Azienda USLL2 Marca Trevigiana, Treviso, Italy., Diomedi M; Stroke Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy., Dorigo W; Vascular Surgery Unit, University of Florence, Florence, Italy., Faggioli G; Vascular Surgery Unit, Policlinico Sant'Orsola, Alma Mater Studiorum University, Bologna, Italy., Giannace G; Vascular Surgery Unit, Arcispedale Snata Maria Nuova, Reggio Emilia, Italy., Giannandrea D; Stroke Unit, Neurology Department, USL Umbria 1, Cittá di Castello, Perugia, Italy., Giannetta M; Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy., Lessiani G; Angiology Unit, Villa Serena Hospital, AUSL 3, Pescara, Italy., Marone EM; Vascular Surgery Unit, Department of Policlinico Monaza, Monza, Italy.; Pavia University, Pavia, Italy., Mazzaccaro D; Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy., Migliacci R; Angiology and Internal Medicine, Valdichiana S.Margherita Hospital, Cortona, Italy., Nano G; Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy., Pagliariccio G; Vascular Surgery Unit, Policlinico Riuniti Hospital University, Ancona, Italy., Petruzzellis M; Neurology and Stroke Unit, Policlinico Hospital University, Bari, Italy., Plutino A; Stroke Unit, Marche Nord Riuniti Hospital, Fano, Italy., Pomatto S; Vascular Surgery Unit, Policlinico Sant'Orsola, Alma Mater Studiorum University, Bologna, Italy., Pulli R; Vascular Surgery Unit, Policlinico Careggi Hospital University, Florence, Italy., Sirignano P; Vascular and Endovascular Surgery Division, Sant'andrea Hospital , 'La sapienza' University of Rome, Rome, Italy., Vacirca A; Vascular Surgery Unit, Policlinico San'Orsola-Alma Mater Studiorum University, Bologna, Italy., Visco E; Division of Cardiology and Interventional Hemodynamic, San Giacomo Apostolo Hospital, Azienda ULSS2 Marca Trevigiana, Castelfranco Veneto, Italy., Moghadam SP; Northwick Park Hospital, London, UK., Lanza G; Vascular Surgery Department, Multimedica Hospital-IRCCS, Castellanza, Italy., Lanza J; Vascular Surgery Department, IRCSS Ospedale Policlinico, San Martino Genova, Italy.
Jazyk: angličtina
Zdroj: Journal of Anesthesia, Analgesia and Critical Care (Online) [J Anesth Analg Crit Care] 2022 Jun 06; Vol. 2 (1), pp. 24. Date of Electronic Publication: 2022 Jun 06.
DOI: 10.1186/s44158-022-00052-9
Abstrakt: 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.
(© 2022. The Author(s).)
Databáze: MEDLINE
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