Cardiac Output and Duplex Sonography in Carotid Endarterectomy

Cardiac Output and Cerebral Blood-flow During Carotid Endarterectomy in Regional vs. General Anesthesia. A Prospective Randomized Controlled Single Center Study

The aim of this study is to investigate the differences between the cardiac output and the cerebral blood-flow between a regional anesthesia (RA) and a general anesthesia (GA) in a randomized, controlled, single center study at the Medical University Innsbruck, Department of Anesthesia and Intensive Care Medicine.

The investigators will investigate the differences between the cardiac output and the cerebral blood-flow between a regional anesthesia (RA) and a general anesthesia (GA) in a randomized, controlled, single center study at the Medical University Innsbruck, Department of Anesthesia and Intensive Care Medicine. For this purpose patients with the need of a carotid endarterectomy (CEA) will be included and randomized either to the regional anesthesia (RA) or the general anesthesia (GA) group until a patient number of 45 in each group is achieved. The cardiac output and cerebral blood-flow via trans-cranial Doppler (TCD) will be measured at 6 time points: T0 Baseline (after insertion of an arterial line) T1 After induction of anesthesia, but before surgical start T2 Two minutes after clamping the carotid artery T3 Two minutes after shunt insertation of the carotid artery T4 After reperfusion T5 After completion of the skin suture

carotid endarterectomy, cardiac output, trans-cranial Doppler, CEA, regional anesthesia, general anesthesia

Regional anesthesia (RA) for a carotid endarterectomy Interventions: Regional anesthesia (RA), blood gas analysis, 'Transcranieller Doppler' (Transcranial Doppler ultrasonography), invasive arterial blood pressure measurement, arterial blood gas measurement, neurological control, Near-infrared spectroscopy (NIRS) monitoring, oxygen supply (not invasive 'Vigileo')

General anesthesia (GA) for a carotid endarterectomy Interventions: General anesthesia, blood gas analysis, 'Transcranieller Doppler' (Transcranial Doppler ultrasonography), invasive arterial blood pressure measurement, arterial blood gas measurement, neurological control, NIRS monitoring, oxygen supply (not invasive 'Vigileo')

Number of participants: 90 patients Unit of measure: Cardiac index (l/m2) Cardiac output will be measured and compared at the following time points: T0 Baseline (after insertion of an arterial line) T1 After induction of anesthesia, but before surgical start T2 Two minutes after clamping the carotid artery T3 Two minutes after shunt insertation of the carotid artery T4 After reperfusion T5 After completion of the skin suture

Cerebral blood flow will be measured via trans-cranial Doppler (TCD) and compared at the following time points: T0 Baseline (after insertion of an arterial line) T1 After induction of anesthesia, but before surgical start T2 Two minutes after clamping the carotid artery T3 Two minutes after shunt insertation of the carotid artery T4 After reperfusion T5 After completion of the skin suture

Change of cardiac output from Baseline to induction of anesthesia and up to 1 hour after admission to the intermediate care unit

Number of participants: 90 patients Unit of measure: blood flow, volume and absolute tissue saturation Near infrared spectroscopy will be measured and compared at the following time points: T0 Baseline (after insertion of an arterial line) T1 After induction of anesthesia, but before surgical start T2 Two minutes after clamping the carotid artery T3 Two minutes after shunt insertation of the carotid artery T4 After reperfusion T5 After completion of the skin suture

Change of cardiac output from Baseline to induction of anesthesia and up to 1 hour after admission to the intermediate care unit

Number of participants: 90 patients Unit of measure: blood pressure in mmHg Blood pressure will be measured and compared at the following time points: T0 Baseline (after insertion of an arterial line) T1 After induction of anesthesia, but before surgical start T2 Two minutes after clamping the carotid artery T3 Two minutes after shunt insertation of the carotid artery T4 After reperfusion T5 After completion of the skin suture

Change of blood pressure, from Baseline to induction of anesthesia and up to 1 hour after admission to the intermediate care unit

Change of heart rate, from Baseline to induction of anesthesia and up to 1 hour after admission to the intermediate care unit Number of participants: 90 patients Unit of measure: beats per minute (bpm) Heart rate will be measured and compared at the following time points: T0 Baseline (after insertion of an arterial line) T1 After induction of anesthesia, but before surgical start T2 Two minutes after clamping the carotid artery T3 Two minutes after shunt insertation of the carotid artery T4 After reperfusion T5 After completion of the skin suture

Change of heart rate, from Baseline to induction of anesthesia and up to 1 hour after admission to the intermediate care unit

Number of participants: 90 patients Unit of measure: arterial oxygen tension (PaO2) Blood pressure will be measured and compared at the following time points: T0 Baseline (after insertion of an arterial line) T1 After induction of anesthesia, but before surgical start T2 Two minutes after clamping the carotid artery T3 Two minutes after shunt insertation of the carotid artery T4 After reperfusion T5 After completion of the skin suture

Change of oxygen saturation in blood, from Baseline to induction of anesthesia and up to 1 hour after admission to the intermediate care unit

Inclusion Criteria: Age >= 18 years Elective carotid endarterectomy Signed informed consent Exclusion Criteria: Age under 18 years Missing signed informed consent