[Carotid endarterectomy : General versus local anesthesia, which is the best ?]

Abstract

This article explores two anesthetic strategies for carotid endarterectomy: cervical plexus block and general anesthesia. Regional anesthesia is increasingly favoured for its ability to enable continuous neurological monitoring and maintain hemodynamic stability. General anesthesia remains essential for certain patients, offering comfort, optimal control of physiological conditions, and extended cerebral protection. We also discuss pathophysiological considerations, crucial elements for understanding patient responses to these techniques. The development of ultrasound-guided cervical plexus block emerges as a promising alternative to general anesthesia, enhancing the options available for safer and more effective anesthetic management. However, an individualized approach remains crucial to optimize clinical outcomes. This approach is part of the concept of «personalized medicine», in which contemporary anesthesia must necessarily be adapted to the specific needs of each individual.