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NEUROSURGICAL ANESTHESIOLOGY

A Study of Cognitive Dysfunction in Patients Having Carotid Endarterectomy Performed with Regional Anesthesia

Eric J. Heyer, MD, PhD^*, Mark I. Gold, MD, E. Will Kirby, BA^*, Joseph Zurica, BA^*, Elizabeth Mitchell, BA^*, Hadi J. Halazun, BA^*, Lauren Teverbaugh, BA^*, Robert R. Sciacca, EngScD, Robert A. Solomon, MD^||, Donald O. Quest, MD^||, Thomas S. Maldonado, MD^¶, Thomas S. Riles, MD^¶, and E. Sander Connolly, Jr, MD^||

From the Departments of *Anesthesiology and Neurology, Columbia University, New York, New York; Department of Anesthesiology, New York University, New York, New York; Departments of Medicine, and ||Neurological Surgery, Columbia University, New York, New York; and ¶Department of Surgery, New York University, New York, New York.

Abstract

BACKGROUND: In previous studies, we found that approximately 25% of patients having carotid endarterectomy with general anesthesia (CEA general) develop cognitive dysfunction compared with a surgical control Group 1 day and 1 mo after surgery. In this study, we tested the hypothesis that patients having CEA with regional anesthesia (CEA regional) will develop significant cognitive dysfunction 1 day after surgery compared with a control group of patients receiving sedation 1 day after surgery. We did not study persistence of dysfunction.

METHODS: To test this hypothesis, we enrolled 60 patients in a prospective study. CEA regional was performed with superficial and deep cervical plexus blocks in 41 patients. The control group consisted of 19 patients having coronary angiography or coronary artery stenting performed with sedation. A control group is necessary to account for the "practice effect" associated with repeated cognitive testing. The patients from the CEA regional group were enrolled at New York Medical Center and the control group at Columbia-Presbyterian Medical Center. The cognitive performance of all patients was evaluated using a previously validated battery of neuropsychometric tests. Differences in performance, 1 day after compared with before surgery, were evaluated by both event-rate and group-rate analyses.

RESULTS: On postoperative day 1, 24.4% of patients undergoing CEA regional had significant cognitive dysfunction, where "significant" was defined as a total deficit score 2 SD worse than the mean performance in the control group.

CONCLUSIONS: Patients undergoing CEA regional had an incidence of cognitive dysfunction which was not different than patients having CEA general as previously published and compared with a contemporaneously enrolled group.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999