IP077. Regional Anesthesia Is Protective Against Postoperative Hypertension in Patients Undergoing Eversion Carotid Endarterectomy

Eversion carotid endarterectomy (eCEA) has been effective in reducing stroke risk in patients with carotid artery stenosis. Recent literature shows patients who undergo eCEA are at risk for developing postoperative hypertension requiring intravenous (IV) antihypertensive medication. The purpose of this study was to assess whether the type of anesthesia (regional or general) impacts the incidence of postoperative hypertension requiring IV antihypertensive medication in the surgical intensive care unit (SICU) in patients undergoing eCEA. We performed a retrospective chart review from August 2009 to March 2013 and identified 124 patients who underwent eCEA. Patient characteristics, including age, gender, body mass index, smoking status, and preoperative diagnosis of hypertension, were collected; operative data, including the use of shunt and type of anesthesia, were also obtained. Descriptive statistics were used to summarize patient and procedure characteristics. The difference between select groups was tested by χ2 analysis with calculating odds ratio and 95% confidence intervals (CIs). A total of 124 patients were analyzed, and 134 eCEA were performed. Of these, 59 (44.0%) were performed under cervical plexus block and 75 (56.0%) were performed under general anesthesia. Thirty-one patients (23.1%) were admitted to the SICU. Of these, 22 (71.0%) were for postoperative hypertension management requiring IV antihypertensive medication. Of the patients admitted to the SICU for postoperative hypertension, 6 patients (27.3%) underwent regional anesthesia compared to 16 patients (72.7%) who had general anesthesia, a statistically significant finding (95% CI, 1.041-8.610). In patients undergoing eCEA, regional anesthesia can be protective against postoperative hypertension, with a reduced requirement for intravenous postoperative antihypertensive medications and SICU admission. Further investigations involving the exact mechanism of this finding and potential cost benefits are warranted.