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Study Shows Carotid Surgery Outcome No Different With Local, General Anaesthesia NEW YORK -- November 26, 2008 -- Anaesthetists and physicians, in consultation with their patients, should decide which of general or local anaesthetic is most appropriate for carotid surgery for each individual case, as a study published early online and in an upcoming edition of The Lancet shows that there is no definite difference in outcomes using either technique. Michael Gough, MD, Department of Vascular Surgery, Leeds General Infirmary, Leeds, United Kingdom, and colleagues conducted the General Anaesthetic Local Anaesthetic (GALA) trial to assess the relative risks of stroke, cardiac events, and death following carotid endarterectomy under either general or local anaesthesia. Prior to the trial, it was thought that operations under local anaesthesia may be safer than under general anaesthesia, partly because awake testing of brain function under local anaesthesia during carotid clamping alerts the surgeon to the need for a shunt more reliably than the various indirect techniques used under general anaesthesia. Consequently, fewer shunts are used. The randomised controlled trial, conducted between 1999 and 2007, analysed 3,526 patients from 95 centres in 24 countries. All patients had symptomatic or asymptomatic carotid artery blockage and were randomly assigned to general anaesthetic (n = 1,753) or local anaesthetic (n = 1,773). The primary outcome was the proportion of patients with stroke (including retinal blood vessel blockage), heart attack, or death between randomisation and 30 days after surgery. The researchers found a similar incidence of primary events in both groups: 4.8% of patients from the general anaesthetic group, compared with 4.5% in the local anaesthetic group. Nor did the 2 groups significantly differ for quality of life, length of hospital stay, or in the prespecified subgroups of age, contralateral carotid occlusion, and baseline surgical risk. "In regard to major perioperative complications of stroke, heart attack, and death, there is no reason to prefer general over local anaesthesia, or vice versa, as routine for carotid endarterectomy," the authors wrote. "Similarly, we showed no definite evidence that the type of anaesthesia affects length of hospital stay or quality of life. Ideally, therefore, surgical and anaesthetic teams should be competent in both techniques because a patient might prefer, or there might be a medical reason to choose one rather than the other." SOURCE: The Lancet E-mail this page to a friend or colleague! To print, use this version