Background and aims The decision for general anesthesia (GA) vs regional anesthesia (RA) for staged carotid endarterectomy (CEA) is an ongoing debate 1 2 and should be done on an individual basis.3 We present a case of a highly-comorbid patient with dilated cardiomyopathy (DCM) undergoing staged CEA using RA.
Methods A 72-year-old patient with previous stroke and soft carotid bifurcation plaque was admitted for right CEA. He experienced an infarction 4 years previously, left untreated, thus developing dilated cardiomyopathy, diabetic with an GFR of 43.7 mL/min/1.73 m2. Preoperative evaluation showed dyspnea at rest NYHA IV; and intermittent chest pain CCS IV. We opted for staged CEA shortly followed by coronary revascularization. Due to minimal invasiveness, RA was chosen because of the high-risk of myocardial infarction, intraoperative stroke and renal insufficiency. Deep cervical plexus block was performed, from C2 to C4 using 10 ml 0,5% bupivacaine and 10 ml 1% lidocaine . Surgery was uneventful and pain free, with stable hemodynamics, using eversion endarterectomy and no shunt.
Results Postoperative recovery was uneventful, patient was discharged on the 2nd day following surgery.
Conclusions Staged CEA in high risk coronary patients can be safely performed using minimal invasive RA. Our ongoing study for RA vs GA in this patient will give definitive answer.