Background and goal of study:carotid endarterectomy(CED) surgery under regional anesthesia offers a series of advantages over general anesthesia. Some of them would be observing neurological symptoms owed to cerebral perfusion deficit, avoiding the expensive cerebral monitoring or reducing the use of intraluminal derivation (ILD). In addition, it brings off more hemodynamic stability and less need of vasoactive drugs. The goal of our study is to describe the efficacy and security of deep cervical plexus block (CPB) in the CED. Furthermore, to analyze the incidence of neurological (NC) and cardiac complications (CC), as well as the reconversion to general anesthesia ́s rate (GAR).
Materials and methods: a descriptive analysis was conducted among a series of 797 patients (652 men and 245 women), that were operated from CED between 1994 and 2016 in our hospital. 3 cases were excluded due to lack of collaboration or presence of contralateral phrenic paralysis. Under CPB (always executed by the same physician) and sedation with Midazolam and Remifentanil, using clinical monitoring, intraoperative events while carotid clamping were observed. Furthermore, early postoperative complications were taken into account. We analyzed preoperative morbility, GAR ́s rate, CPB complications , NC, CC and mortality.
Results and discussion: the main morbility factor was arterial hypertension, which was present in 70.1%. The 61.1% smoked, 14.2% suffered from ischemic cardiopathy, 10.4% were diabetic and 10.1% of them were over 80 years. Around 90% tolerated the clamping with CPB without any neurological symptoms; only in 9.2% ILD was necessary. In 0.75% of the CPB some complications were observed (0.25% for respiratory insufficiency, 0.5% for toxicity of local anesthetic). Only 1.6% had RAG (0.6% for pain, 0.8% for neurological symptoms in spite of ILD, 0.3% for respiratory insufficiency). During postoperative recovery, NC were observed in 3.6% cases and CC in 4.1%. Mortality rate was 1.1%.+
Conclusions: Our experience with 800 cases demonstrates that DEC surgery could be performed with CPB and sedation exclusively due to its low complication rate. Constant clinical evaluation during the procedure benefits from observing any neurological symptoms secondary to cerebral perfusion deficit. Moreover, ILD could be carried out in selected patients. RAG rate is low in our study. Nevertheless, the morbimortality is similar than other bigger case series.

09 / Carotid endarterectomy surgery with deep cervical plexus block. Our experience with 800 cases.