Anästhesie und klinische Forschung
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Abstrakt

The Cardiovascular Side Effects during Carotid Artery Stenting under Ultrasound-Guided Carotid Sheath Block

Chantal Hager, David Schurter, Guido Schuepfer, Christoph Konrad, Mattias Casutt

Background: The aim of this study was to determine if the implementation of a carotid sheath block will provide more hemodynamic stability during carotid artery stenting compared with no regional anesthesia procedure for this intervention.

Methods: Since 2014, we have been routinely conducting carotid artery stenting with carotid sheath block in our hospital. A quality-process control survey with before-after design has been performed. The period between January 2012 and December 2013 was before the introduction of regional anesthesia for carotid artery stenting and the period between January 2014 and December 2017 was after its introduction. During the observation, 142 consecutive elective carotid artery stenting interventions were analyzed. Blood pressure, heart rate and the administration of atropine sulphate, catecholamine and vasodilator respectively until 20 minutes after balloon dilatation were examined.

Results: At the beginning of the intervention, the block group showed enhanced hemodynamic parameters as blood pressure and heart rate with an increased demand of vasodilating medications ( chi² 7.15, df 1, p=0.008). After carotid artery stenting, we found a lower incidence of asystole and bradycardia (chi² 4.27, df 1, p=0.04) as well as a lower incidence of atropine administration (chi² 12.10, df 1, p=0.001). There was no difference of cardiovascular active medication between the two groups (chi² 2.17, df 1, p=0.14).

Conclusion: Implementation of a carotid sheath block before carotid artery stenting shows a tendency towards more stable hemodynamic parameters during the intervention with significantly lower incidence of atropine administration due to bradycardia ( < 25 beats/min) and asystole.