دورية أكاديمية
General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis.
| العنوان: | General Anesthesia Versus Local Anesthesia in Carotid Endarterectomy: A Systematic Review and Meta-Analysis. |
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| المؤلفون: | Harky A; Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom. Electronic address: aaharky@gmail.com., Chan JSK; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong., Kot TKM; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong., Sanli D; Gundogmus State Hospital, Antalya, Turkey., Rahimli R; Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey., Belamaric Z; Department of Perioperative Medicine, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom., Ng M; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong., Kwan IYY; Faculty of Medicine, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong., Bithas C; School of Medicine, University of Liverpool, Liverpool, United Kingdom., Makar R; Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom., Chandrasekar R; Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom., Dimitri S; Department of Vascular Surgery, Countess of Chester, Chester, United Kingdom. |
| المصدر: | Journal of cardiothoracic and vascular anesthesia [J Cardiothorac Vasc Anesth] 2020 Jan; Vol. 34 (1), pp. 219-234. Date of Electronic Publication: 2019 Mar 18. |
| نوع المنشور: | Journal Article; Meta-Analysis; Review; Systematic Review |
| اللغة: | English |
| بيانات الدورية: | Publisher: W.B. Saunders Country of Publication: United States NLM ID: 9110208 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-8422 (Electronic) Linking ISSN: 10530770 NLM ISO Abbreviation: J Cardiothorac Vasc Anesth Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Philadelphia, PA : W.B. Saunders, c1991- |
| مواضيع طبية MeSH: | Carotid Stenosis*/surgery , Endarterectomy, Carotid*/adverse effects , Stroke*, Adult ; Anesthesia, General ; Anesthesia, Local ; Humans ; Risk Factors ; Treatment Outcome |
| مستخلص: | Objective: The choice of anesthetic technique in carotid endarterectomy (CEA) has been controversial. This study compared the outcomes of general anesthesia (GA) and local anesthesia (LA) in CEA. Design: Systematic review and meta-analysis of comparative studies. Setting: Hospitals. Participants: Adult patients undergoing CEA with either LA or GA. Interventions: The effects of GA and LA on CEA outcomes were compared. Measurements and Main Results: PubMed, OVID, Scopus, and Embase were searched to June 2018. Thirty-one studies with 152,376 patients were analyzed. A random effect model was used, and heterogeneity was assessed with the I 2 and chi-square tests. LA was associated with shorter surgical time (weighted mean difference -9.15 min [-15.55 to -2.75]; p = 0.005) and less stroke (odds ratio [OR] 0.76 [0.62-0.92]; p = 0.006), cardiac complications (OR 0.59 [0.47-0.73]; p < 0.00001), and in-hospital mortality (OR 0.72 [0.59-0.90]; p = 0.003). Transient neurologic deficit rates were similar (OR 0.69 [0.46-1.04]; p = 0.07). Heterogeneity was significant for surgical time (I 2 = 0.99, chi-square = 1,336.04; p < 0.00001), transient neurologic deficit (I 2 = 0.41, chi-square = 28.81; p = 0.04), and cardiac complications (I 2 = 0.42, chi-square = 43.32; p = 0.01) but not for stroke (I 2 = 0.22, chi-square = 30.72; p = 0.16) and mortality (I 2 = 0.00, chi-square = 21.69; p = 0.65). Randomized controlled trial subgroup analysis was performed, and all the aforementioned variables were not significantly different or heterogenous. Conclusion: The results from this study showed no inferiority of using LA to GA in patients undergoing CEA. Future investigations should be reported more systematically, preferably with randomization or propensity-matched analysis, and thus registries will facilitate investigation of this subject. Anesthetic choice in CEA should be individualized and encouraged where applicable. (Copyright © 2019 Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: anesthetic technique; carotid endarterectomy; general anesthesia; local anesthesia |
| تواريخ الأحداث: | Date Created: 20190511 Date Completed: 20210427 Latest Revision: 20210427 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1053/j.jvca.2019.03.029 |
| PMID: | 31072705 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1532-8422 |
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| DOI: | 10.1053/j.jvca.2019.03.029 |