Objectives: Increased perioperative plasma concentration of cortisol is a marker of intraoperative stress. We assumed, that carotid endarterectomy (CEA) performed under awake sedation with propofol is more beneficial to prevent such stress than alprazolam premedication only.
Methods: A total of 40 consecutive patients with significant carotid artery stenosis were enrolled into this prospective study. All operations were performed in regional anaesthesia. As premedication, all patients took 0.5 mg alprazolam 30 minutes before the procedure. After randomization 20 patients had awake sedation with target controlled propofol infusion (TCI), the other 20 had only premedication (BDZ). Cortisol plasma levels were serially analysed: prior to surgery (T1), before (T2) and after release of carotid clamp (T3), at 2 (T4) and 24 post-operative hours (T5). Alprazolam levels were also measured before and after the surgery. 
Results: The plasma concentration of cortisol was significantly lower in the TCI group at both T3 (p=0.04) and T4 (p=0.006) compared to BDZ group. Alprazolam levels did not correlate with cortisol levels at any time point. A significant positive correlation was found between the clamp time and plasma cortisol level at T3 (p=0.01), similarly between the degree of contralateral carotid stenosis and plasma cortisol level at T3 (p=0.03).
Conclusion: Intraoperative propofol sedation provides better stress relief compared to alprazolam premedication during awake CEA.
References:
1.	Marrocco-Trischitta MM, Tiezzi A, Svampa MG et al. Perioperative stress response to carotid endarterectomy: the impact of anesthetic modality. J Vasc Surg. 2004; 39:1295-304.
2.	H. Krenn, E. Deusch, H. Jellinek et al. Remifentanil or propofol for sedation during carotid endarterectomy under cervical plexus block. Br J Anaesth 2002; 89: 637-40

03 / Awake sedation with propofol during carotid endarterctomy provides better stress relief compared to alprazolam premedication alone