Recent evidence suggests no difference between patient outcomes when carotid endarterectomies (CEAs) are performed under general or regional anesthesia. However, for detecting the need for a shunt, general anesthesia has the drawback of monitoring needs in the intraoperative setting. In the present study, we attempted to perform intraoperative transcranial Doppler (TCD) monitoring for CEAs performed under intermediate plexus block to describe cerebral hemodynamic changes during different phases of the procedure. Patients and methods Patients with unilateral hemodynamically significant carotid stenosis scheduled for elective CEAs were included. Ultrasound-guided intermediate plexus block was used for regional anesthesia. TCD monitoring of the middle cerebral artery mean blood flow velocity (MCAV) was performed throughout the procedure. MCAVs were offline analyzed during different phases of CEA: (1) resting state, before regional block, (2) after block, before incision, (3) before cross-clamp, (4) after cross-clamp, (5) 5 min after cross-clamp, (6) 10 min after cross-clamp, (7) after declamping, and (8) during the postoperative period (4-6 h). Results Shunt insertion based on the deterioration of neurological symptoms after cross-clamping was necessary for 11/66 patients (16.6%). In these symptomatic patients, the ipsilateral percent decrease of the MCAV was more than 70% in 8 out of 11 cases (72.7%). In asymptomatic patients, without shunt insertion, the average decrease of MCAV was less than 50%. Conclusions Neurological symptoms referring to cerebral ischemia may be superior to TCD monitoring of cerebral blood flow for detecting the necessity of a shunt. Regional anesthesia enables reliable, symptom-based monitoring of CEAs.

中文翻译：

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区域麻醉下颈动脉内膜切除术中经颅多普勒监测脑血流变化的价值——病例系列。

最近的证据表明，在全身麻醉或区域麻醉下进行颈动脉内膜切除术 (CEA) 时，患者的预后没有差异。然而，为了检测是否需要分流，全身麻醉存在术中监测需求的缺点。在本研究中，我们尝试对在中间丛阻滞下进行的 CEA 进行术中经颅多普勒 (TCD) 监测，以描述手术不同阶段的脑血流动力学变化。患者和方法 计划进行择期 CEA 的单侧血流动力学显着颈动脉狭窄患者被纳入。超声引导中间丛阻滞用于区域麻醉。在整个过程中进行大脑中动脉平均血流速度 (MCAV) 的 TCD 监测。在 CEA 的不同阶段对 MCAV 进行了离线分析：(1) 静息状态，区域阻滞前，(2) 阻滞后，切开前，(3) 横钳前，(4) 横钳后，(5) 5 分钟交叉夹紧后，(6) 交叉夹紧后 10 分钟，(7) 松开后，以及 (8) 术后期间（4-6 小时）。结果 11/66 (16.6%) 患者需要根据钳夹后神经系统症状的恶化插入分流管。在这些有症状的患者中，11 例患者中有 8 例 (72.7%) 的同侧 MCAV 下降百分比超过 70%。在没有插入分流器的无症状患者中，MCAV 的平均下降小于 50%。结论 与脑缺血有关的神经系统症状在检测分流必要性方面可能优于 TCD 监测脑血流。