Anesthetic management of carotid endarterectomy: an update from Italian guidelines

Sergio Bevilacqua¹, Giulia Ticozzelli², Massimiliano Orso³, Giuseppe Alba⁴, Laura Capoccia⁵, Alessandro Cappelli⁶, Carlo Cernetti⁷, Marina Diomedi⁸, Walter Dorigo⁹, Gianluca Faggioli¹⁰, Giovanni Giannace¹¹, David Giannandrea¹², Matteo Giannetta¹³, Gianfranco Lessiani¹⁴, Enrico Maria Marone^{15

16}, Daniela Mazzaccaro¹³, Rino Migliacci¹⁷, Giovanni Nano¹³, Gabriele Pagliariccio¹⁸, Marco Petruzzellis¹⁹, Andrea Plutino²⁰, Sara Pomatto¹⁰, Raffaele Pulli²¹, Pasqualino Sirignano²², Andrea Vacirca²³, Emanuele Visco²⁴, Shadeh Parsapour Moghadam²⁵, Gaetano Lanza²⁶, Jessica Lanza²⁷

Affiliations

¹ Department of Anesthesia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
² Anesthesiology and Intensive Care Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy. g.ticozzelli@smatteo.pv.it.
³ Società Italiana di Chirurgia Vascolare ed Endovascolare (SICVE), Roma, Italy.
⁴ Department of Vascular Surgery, University of Siena, Siena, Italy.
⁵ Vascular and Endovascular Surgery Division, Policlinico Umberto I La Sapienza University of Rome, Rome, Italy.
⁶ Vascular Surgery Unit, Policlinico Le Scotte Hospital University of Siena, Siena, Italy.
⁷ Division of Cardiology and and Interventional Hemodynamics, Ca' Foncello Hospital, Azienda USLL2 Marca Trevigiana, Treviso, Italy.
⁸ Stroke Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy.
⁹ Vascular Surgery Unit, University of Florence, Florence, Italy.
¹⁰ Vascular Surgery Unit, Policlinico Sant'Orsola, Alma Mater Studiorum University, Bologna, Italy.
¹¹ Vascular Surgery Unit, Arcispedale Snata Maria Nuova, Reggio Emilia, Italy.
¹² Stroke Unit, Neurology Department, USL Umbria 1, Cittá di Castello, Perugia, Italy.
¹³ Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy.
¹⁴ Angiology Unit, Villa Serena Hospital, AUSL 3, Pescara, Italy.
¹⁵ Vascular Surgery Unit, Department of Policlinico Monaza, Monza, Italy.
¹⁶ Pavia University, Pavia, Italy.
¹⁷ Angiology and Internal Medicine, Valdichiana S.Margherita Hospital, Cortona, Italy.
¹⁸ Vascular Surgery Unit, Policlinico Riuniti Hospital University, Ancona, Italy.
¹⁹ Neurology and Stroke Unit, Policlinico Hospital University, Bari, Italy.
²⁰ Stroke Unit, Marche Nord Riuniti Hospital, Fano, Italy.
²¹ Vascular Surgery Unit, Policlinico Careggi Hospital University, Florence, Italy.
²² Vascular and Endovascular Surgery Division, Sant'andrea Hospital , "La sapienza" University of Rome, Rome, Italy.
²³ Vascular Surgery Unit, Policlinico San'Orsola-Alma Mater Studiorum University, Bologna, Italy.
²⁴ Division of Cardiology and Interventional Hemodynamic, San Giacomo Apostolo Hospital, Azienda ULSS2 Marca Trevigiana, Castelfranco Veneto, Italy.
²⁵ Northwick Park Hospital, London, UK.
²⁶ Vascular Surgery Department, Multimedica Hospital-IRCCS, Castellanza, Italy.
²⁷ Vascular Surgery Department, IRCSS Ospedale Policlinico, San Martino Genova, Italy.

PMID: 37386522
PMCID: PMC10245611
DOI: 10.1186/s44158-022-00052-9

Anesthetic management of carotid endarterectomy: an update from Italian guidelines

Sergio Bevilacqua et al. J Anesth Analg Crit Care. 2022.

. 2022 Jun 6;2(1):24.

doi: 10.1186/s44158-022-00052-9.

Authors

Affiliations

¹ Department of Anesthesia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
² Anesthesiology and Intensive Care Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy. g.ticozzelli@smatteo.pv.it.
³ Società Italiana di Chirurgia Vascolare ed Endovascolare (SICVE), Roma, Italy.
⁴ Department of Vascular Surgery, University of Siena, Siena, Italy.
⁵ Vascular and Endovascular Surgery Division, Policlinico Umberto I La Sapienza University of Rome, Rome, Italy.
⁶ Vascular Surgery Unit, Policlinico Le Scotte Hospital University of Siena, Siena, Italy.
⁷ Division of Cardiology and and Interventional Hemodynamics, Ca' Foncello Hospital, Azienda USLL2 Marca Trevigiana, Treviso, Italy.
⁸ Stroke Unit, Department of Systems Medicine, Tor Vergata University Hospital, Rome, Italy.
⁹ Vascular Surgery Unit, University of Florence, Florence, Italy.
¹⁰ Vascular Surgery Unit, Policlinico Sant'Orsola, Alma Mater Studiorum University, Bologna, Italy.
¹¹ Vascular Surgery Unit, Arcispedale Snata Maria Nuova, Reggio Emilia, Italy.
¹² Stroke Unit, Neurology Department, USL Umbria 1, Cittá di Castello, Perugia, Italy.
¹³ Vascular Surgery Unit, IRCCS Policlinico San Donato Hospital University, San Donato Milanese, Italy.
¹⁴ Angiology Unit, Villa Serena Hospital, AUSL 3, Pescara, Italy.
¹⁵ Vascular Surgery Unit, Department of Policlinico Monaza, Monza, Italy.
¹⁶ Pavia University, Pavia, Italy.
¹⁷ Angiology and Internal Medicine, Valdichiana S.Margherita Hospital, Cortona, Italy.
¹⁸ Vascular Surgery Unit, Policlinico Riuniti Hospital University, Ancona, Italy.
¹⁹ Neurology and Stroke Unit, Policlinico Hospital University, Bari, Italy.
²⁰ Stroke Unit, Marche Nord Riuniti Hospital, Fano, Italy.
²¹ Vascular Surgery Unit, Policlinico Careggi Hospital University, Florence, Italy.
²² Vascular and Endovascular Surgery Division, Sant'andrea Hospital , "La sapienza" University of Rome, Rome, Italy.
²³ Vascular Surgery Unit, Policlinico San'Orsola-Alma Mater Studiorum University, Bologna, Italy.
²⁴ Division of Cardiology and Interventional Hemodynamic, San Giacomo Apostolo Hospital, Azienda ULSS2 Marca Trevigiana, Castelfranco Veneto, Italy.
²⁵ Northwick Park Hospital, London, UK.
²⁶ Vascular Surgery Department, Multimedica Hospital-IRCCS, Castellanza, Italy.
²⁷ Vascular Surgery Department, IRCSS Ospedale Policlinico, San Martino Genova, Italy.

PMID: 37386522
PMCID: PMC10245611
DOI: 10.1186/s44158-022-00052-9

Abstract

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.

Keywords: Anesthesia; Blood pressure monitoring; Carotid endarterectomy; Guidelines; Heparin reversal; Intraoperative cerebral monitoring; Recommendations.

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Conflict of interest statement

The authors declare that they have no competing interests.

References

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Anesthetic management of carotid endarterectomy: an update from Italian guidelines

Affiliations

Anesthetic management of carotid endarterectomy: an update from Italian guidelines

Authors

Affiliations

Abstract

Conflict of interest statement

References

LinkOut - more resources

Full Text Sources