PDF(Pubmed)
Abstract：
BACKGROUND: Carotid endarterectomy is performed for patients with symptomatic carotid artery occlusions. Surgery can be performed under general and regional anesthesia. Traditionally, surgery is performed under deep cervical plexus block which is technically difficult to perform and can cause serious complications. This case series describes 5 cases in which an intermediate cervical plexus block was used in combination with a superficial cervical plexus block for Carotid endarterectomy surgery.
METHODS: Five patients who were classified as American Society of Anesthesiologists 2-3 were scheduled for Carotid endarterectomy due to symptoms and more than 70% occlusion of the carotid arteries. The procedures were carried out in the University Teaching Hospital- Peradeniya, Sri Lanka. All patients were given superficial cervical plexus block followed by intermediate cervical plexus block using 2% lignocaine and 0.5% plain bupivacaine.
RESULTS: Adequate anesthesia was achieved in 4 patients, and local infiltration was necessary in 1 patient. Two patients developed hoarseness of the voice, which settled 2 h after surgery. Hemodynamic fluctuations were observed in all 5 patients. No serious complications were observed. All 5 patients had uneventful recoveries.
CONCLUSIONS: Regional anesthesia for CEA is preferable in patients who are medically complicated to undergo anesthesia or in patients for whom cerebral monitoring is not available. Intermediate cervical plexus block is described for thyroid surgeries in literature, but not much details on its use for carotid surgeries. Deep cervical plexus blocks has few serious complications which is not there with the use of ICPB making it a good alternative for CEA surgeries .
CONCLUSIONS: Superficial cervical plexus block and intermediate cervical plexus block can be used effectively for providing anesthesia for patients undergoing Carotid endarterectomy. It is safe and easier to conduct than deep cervical plexus block and enables monitoring of cerebral function.
METHODS: Five patients who were classified as American Society of Anesthesiologists 2-3 were scheduled for Carotid endarterectomy due to symptoms and more than 70% occlusion of the carotid arteries. The procedures were carried out in the University Teaching Hospital- Peradeniya, Sri Lanka. All patients were given superficial cervical plexus block followed by intermediate cervical plexus block using 2% lignocaine and 0.5% plain bupivacaine.
RESULTS: Adequate anesthesia was achieved in 4 patients, and local infiltration was necessary in 1 patient. Two patients developed hoarseness of the voice, which settled 2 h after surgery. Hemodynamic fluctuations were observed in all 5 patients. No serious complications were observed. All 5 patients had uneventful recoveries.
CONCLUSIONS: Regional anesthesia for CEA is preferable in patients who are medically complicated to undergo anesthesia or in patients for whom cerebral monitoring is not available. Intermediate cervical plexus block is described for thyroid surgeries in literature, but not much details on its use for carotid surgeries. Deep cervical plexus blocks has few serious complications which is not there with the use of ICPB making it a good alternative for CEA surgeries .
CONCLUSIONS: Superficial cervical plexus block and intermediate cervical plexus block can be used effectively for providing anesthesia for patients undergoing Carotid endarterectomy. It is safe and easier to conduct than deep cervical plexus block and enables monitoring of cerebral function.
摘要：
背景：颈动脉内膜切除术用于有症状的颈动脉闭塞患者。手术可以在全身和区域麻醉下进行。传统上,手术是在深颈丛阻滞下进行的，这在技术上是很难进行的，并且会引起严重的并发症。本病例系列描述了5例病例，其中中间颈丛阻滞与浅表颈丛阻滞联合用于颈动脉内膜切除术。
方法：5名被归类为美国麻醉医师协会2-3的患者因症状和超过70%的颈动脉闭塞而计划进行颈动脉内膜切除术。这些程序是在大学教学医院-Peradeniya进行的，斯里兰卡。所有患者均给予浅颈丛阻滞，然后使用2％利多卡因和0.5％布比卡因进行中间颈丛阻滞。
结果：有4例患者获得了充分的麻醉，1例患者需要局部浸润。两个病人出现声音嘶哑,在手术后2小时稳定下来。5例患者均出现血流动力学波动。无严重并发症发生。所有5例患者均恢复顺利。
结论：CEA的区域麻醉在医学上复杂的患者或无法进行脑监测的患者中是优选的。文献中描述了中间颈丛阻滞用于甲状腺手术，但关于它在颈动脉手术中的用途没有太多的细节。深颈丛阻滞几乎没有严重的并发症，而ICPB的使用使其成为CEA手术的良好替代品。
结论：颈浅丛阻滞和中间颈丛阻滞可有效用于颈动脉内膜切除术患者的麻醉。它比深颈丛阻滞更安全，更容易进行，并且可以监测脑功能。
方法：5名被归类为美国麻醉医师协会2-3的患者因症状和超过70%的颈动脉闭塞而计划进行颈动脉内膜切除术。这些程序是在大学教学医院-Peradeniya进行的，斯里兰卡。所有患者均给予浅颈丛阻滞，然后使用2％利多卡因和0.5％布比卡因进行中间颈丛阻滞。
结果：有4例患者获得了充分的麻醉，1例患者需要局部浸润。两个病人出现声音嘶哑,在手术后2小时稳定下来。5例患者均出现血流动力学波动。无严重并发症发生。所有5例患者均恢复顺利。
结论：CEA的区域麻醉在医学上复杂的患者或无法进行脑监测的患者中是优选的。文献中描述了中间颈丛阻滞用于甲状腺手术，但关于它在颈动脉手术中的用途没有太多的细节。深颈丛阻滞几乎没有严重的并发症，而ICPB的使用使其成为CEA手术的良好替代品。
结论：颈浅丛阻滞和中间颈丛阻滞可有效用于颈动脉内膜切除术患者的麻醉。它比深颈丛阻滞更安全，更容易进行，并且可以监测脑功能。
