Background and aims: In order to systematically review the latest evidence on anesthesia, intraoperative neurologic monitoring, postoperative heparin reversal, and postoperative blood pressure management for carotid endarterectomy. The present review is based on a single chapter of the Italian Health Institute Guidelines for diagnosis and treatment of extracranial carotid stenosis and stroke prevention. Methods and results: A systematic article review focused on the previously cited topics published between January 2016 and October 2020 has been performed; we looked for both primary and secondary studies in the extensive archive of Medline/PubMed and Cochrane library databases. We selected 14 systematic reviews and meta-analyses, 13 randomized controlled trials, 8 observational studies, and 1 narrative review. Based on this analysis, syntheses of the available evidence were shared and recommendations were indicated complying with the GRADE-SIGN version methodology. Conclusions: From this up-to-date analysis, it has emerged that any type of anesthesia and neurological monitoring method is related to a better outcome after carotid endarterectomy. In addition, insufficient evidence was found to justify reversal or no-reversal of heparin at the end of surgery. Furthermore, despite a low evidence level, a suggestion for blood pressure monitoring in the postoperative period was formulated.
Anesthetic management of carotid endarterectomy: an update from Italian guidelines / S. Bevilacqua, G. Ticozzelli, M. Orso, G. Alba, L. Capoccia, A. Cappelli, C. Cernetti, M. Diomedi, W. Dorigo, G. Faggioli, G. Giannace, D. Giannandrea, M. Giannetta, G. Lessiani, E.M. Marone, D. Mazzaccaro, R. Migliacci, G. Nano, G. Pagliariccio, M. Petruzzellis, A. Plutino, S. Pomatto, R. Pulli, P. Sirignano, A. Vacirca, E. Visco, S.P. Moghadam, G. Lanza, J. Lanza. - In: JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE. - ISSN 2731-3786. - 2:1(2022), pp. 24.1-24.12. [10.1186/s44158-022-00052-9]
Anesthetic management of carotid endarterectomy: an update from Italian guidelines
A. Cappelli;M. Giannetta;D. Mazzaccaro;G. Nano;J. LanzaUltimo
2022
Abstract
Background and aims: In order to systematically review the latest evidence on anesthesia, intraoperative neurologic monitoring, postoperative heparin reversal, and postoperative blood pressure management for carotid endarterectomy. The present review is based on a single chapter of the Italian Health Institute Guidelines for diagnosis and treatment of extracranial carotid stenosis and stroke prevention. Methods and results: A systematic article review focused on the previously cited topics published between January 2016 and October 2020 has been performed; we looked for both primary and secondary studies in the extensive archive of Medline/PubMed and Cochrane library databases. We selected 14 systematic reviews and meta-analyses, 13 randomized controlled trials, 8 observational studies, and 1 narrative review. Based on this analysis, syntheses of the available evidence were shared and recommendations were indicated complying with the GRADE-SIGN version methodology. Conclusions: From this up-to-date analysis, it has emerged that any type of anesthesia and neurological monitoring method is related to a better outcome after carotid endarterectomy. In addition, insufficient evidence was found to justify reversal or no-reversal of heparin at the end of surgery. Furthermore, despite a low evidence level, a suggestion for blood pressure monitoring in the postoperative period was formulated.File | Dimensione | Formato | |
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