초록접수 현황
| 15F-032 | 구연 발표 |
Regional Anesthesia with Dexmedetomidine Infusion is Feasible Method for the Awake Test during Carotid Endarterectomy
Sung Woon Chung, M.D.¹, Sang-pil Kim, M.D.¹, Chung Won Lee, M.D.¹, Sang Min Sung, M.D.², Han Jin Cho, M.D.², Seunghwan Song, M.D.¹
Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea¹, Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea²
Background : Carotid endarterectomy (CEA) is a standard treatment modality to prevent stroke in patient with carotid stenosis. To reduce the use of shunt, the awake test seems most reliable method to measure the hypoperfusion when the artery clamped. This study reports our experience of routine awake test during CEA under regional anesthesia combined with light sedation by dexmedetomidine infusion.
Methods : From April 2013 to June 2015, 23 patients who had done CEA were retrospectively reviewed from prospectively collected data. All patients underwent the cervical plexus block and the sedation using continuous dexmedetomidine infusion. The need for shunt placement was determined by the awake test at before and 5 minutes after clamp. When the alteration occurs on the neurologic examination, Pruitt-Inahara shunt was placed.
Results : Mean operation time and mean clamp time were 108.6±20.1 minutes and 30.1±6.9 minutes, respectively. Selective shunt placement was performed in three patients(7.7%). There was no perioperative stroke, myocardial infarction or death. All patients underwent CT angiography after surgery to confirm the patency. There was no residual stenosis, thrombosis or dissection. One patient had a hypoglossal nerve injury but recovered fully before discharge. Mean hospital stay was 7.5±2.6 days. During 9.2±8.8 months follow-up, there was no death, stroke, and restenosis.
Conclusion : Regional anesthesia with dexmedetomidine infusion could be feasible method for the awake test during CEA with low shunt placement rate in selected patients.
Methods : From April 2013 to June 2015, 23 patients who had done CEA were retrospectively reviewed from prospectively collected data. All patients underwent the cervical plexus block and the sedation using continuous dexmedetomidine infusion. The need for shunt placement was determined by the awake test at before and 5 minutes after clamp. When the alteration occurs on the neurologic examination, Pruitt-Inahara shunt was placed.
Results : Mean operation time and mean clamp time were 108.6±20.1 minutes and 30.1±6.9 minutes, respectively. Selective shunt placement was performed in three patients(7.7%). There was no perioperative stroke, myocardial infarction or death. All patients underwent CT angiography after surgery to confirm the patency. There was no residual stenosis, thrombosis or dissection. One patient had a hypoglossal nerve injury but recovered fully before discharge. Mean hospital stay was 7.5±2.6 days. During 9.2±8.8 months follow-up, there was no death, stroke, and restenosis.
Conclusion : Regional anesthesia with dexmedetomidine infusion could be feasible method for the awake test during CEA with low shunt placement rate in selected patients.
책임저자: Seunghwan Song
Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
연락처 : Seunghwan Song, Tel: 051-240-7267 , E-mail : song77.sh@gmail.com
