{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:13:42Z","timestamp":1791231222653,"version":"4.1.0"},"reference-count":56,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,7,31]],"date-time":"2018-07-31T00:00:00Z","timestamp":1532995200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Controversy exists regarding the best choice of anaesthesia for carotid endarterectomy. We aimed to evaluate the peri\u2010operative outcomes of local vs. general anaesthesia for carotid endarterectomy. We conducted a systematic search of electronic information sources and applied a combination of free text and controlled vocabulary searches adapted to thesaurus headings, search operators and limits in each of the electronic databases. We defined peri\u2010operative stroke, transient ischaemic attack, mortality and myocardial infarction as the primary outcome measures. We identified 12 randomised controlled trials and 21 observational studies reporting a total of 58,212 patients undergoing carotid endarterectomy under local or general anaesthesia. Analysis of observational studies demonstrated that local anaesthesia was associated with a significantly lower incidence of stroke (\n                    <jats:styled-content style=\"fixed-case\">odds ratio<\/jats:styled-content>\n                    (OR (95% CI) 0.66 (0.55\u20130.80), p\u00a0&lt;\u00a00.0001), transient ischaemic attack (0.52 (0.38\u20130.70), p\u00a0&lt;\u00a00.0001), myocardial infarction (0.55 (0.41\u20130.75), p\u00a0=\u00a00.0002) and mortality (0.72 (0.56\u20130.94), p\u00a0=\u00a00.01) compared with general anaesthesia. Analysis of randomised controlled trials did not find a significant difference in the risk of stroke (0.92 (0.67\u20131.28), p\u00a0=\u00a00.63), transient ischaemic attack (2.20 (0.48\u201310.03), p\u00a0=\u00a00.31), myocardial infarction (1.25 (0.57\u20132.72), p\u00a0=\u00a00.58) or mortality (0.61 (0.35\u20131.05), p\u00a0=\u00a00.07) between local and general anaesthesia. On trial sequential analysis of the randomised trials, the Z\u2010curve did not cross the \u03b1\u2010spending boundaries or futility boundaries for stroke, mortality and transient ischaemic attack, suggesting that more trials are needed to reach conclusive results. Our meta\u2010analysis of observational studies suggests that local anaesthesia for carotid endarterectomy may be associated with lower peri\u2010operative morbidity and mortality compared with general anaesthesia. Although randomised studies have not confirmed any advantage for local anaesthesia, this may be due to a lack of pooled statistical power in these trials.\n                  <\/jats:p>","DOI":"10.1111\/anae.14320","type":"journal-article","created":{"date-parts":[[2018,7,31]],"date-time":"2018-07-31T04:06:17Z","timestamp":1533009977000},"page":"1280-1289","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Meta\u2010analysis and trial sequential analysis of local vs. general anaesthesia for carotid endarterectomy"],"prefix":"10.1111","volume":"73","author":[{"given":"S.","family":"Hajibandeh","sequence":"first","affiliation":[{"name":"Department of General Surgery Stepping Hill Hospital Stockport UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Hajibandeh","sequence":"additional","affiliation":[{"name":"Department of General Surgery Royal Bolton Hospital Bolton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. A.","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Department of General Surgery University Hospital of Heraklion University of Crete Heraklion Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Torella","sequence":"additional","affiliation":[{"name":"Liverpool Vascular and Endovascular Service Royal Liverpool University Hospital Liverpool UK"},{"name":"School of Physical Sciences University of Liverpool Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. A.","family":"Antoniou","sequence":"additional","affiliation":[{"name":"Department of Vascular and Endovascular Surgery The Royal Oldham Hospital Pennine Acute Hospitals NHS Trust Manchester UK"},{"name":"Honorary Senior Lecturer Division of Cardiovascular Sciences School of Medical Sciences University of Manchester Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,7,31]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.12.2513"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199108153250701"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)09292-1"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15785-1"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.120030"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61699-2"},{"key":"e_1_2_6_8_1","first-page":"CD000126","article-title":"Local versus general anaesthesia for carotid endarterectomy","volume":"12","author":"Vaniyapong T","year":"2013","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2015.07.032"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2006.03.035"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1038\/ncpcardio1307"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0962280207080640"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2700"},{"key":"e_1_2_6_14_1","volume-title":"Cochrane handbook for systematic reviews of interventions","author":"Higgins JP"},{"key":"e_1_2_6_15_1","unstructured":"WellsGA SheaB O'ConnellD et\u00a0al.The Newcastle\u2010Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta\u2010analyses.http:\/\/www.ohri.ca\/programs\/clinical_epidemiology\/oxford.asp. (accessed 20\/10\/2016)."},{"key":"e_1_2_6_16_1","first-page":"1","volume-title":"User manual for trial sequential analysis (TSA)","author":"Thorlund K","year":"2011"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/1708538114537489"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-011-1270-4"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/1538574411431345"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2010.04.001"},{"key":"e_1_2_6_21_1","first-page":"496","article-title":"Carotid endarterectomy: general anaesthesia with remifentanyl conscious sedation vs. loco\u2010regional anaesthesia","volume":"28","author":"Marcucci G","year":"2009","journal-title":"International Angiology"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2008.03.009"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/00015458.2007.11680011"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1479-666X(06)80086-7"},{"key":"e_1_2_6_25_1","first-page":"771","article-title":"Comparison between local and general anaesthesia for carotid endarterectomy. A retrospective analysis","volume":"70","author":"Santamaria G","year":"2004","journal-title":"Minerva Anestesiologica"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s100169910026"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0967-2109(00)00057-0"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1078-5884(97)80048-2"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(96)70040-X"},{"key":"e_1_2_6_30_1","first-page":"125","article-title":"Regional\/local anesthesia: a safe and reasonable choice for patients undergoing carotid endarterectomy","volume":"46","author":"Buchbinder D","year":"1997","journal-title":"Maryland Medical Journal"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1078-5884(96)80103-1"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1987.01400190073014"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(86)90450-2"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(83)90043-0"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-198207000-00013"},{"key":"e_1_2_6_36_1","first-page":"323","article-title":"Carotid endarterectomy: regional versus general anesthesia","volume":"46","author":"Anderson CA","year":"1980","journal-title":"American Surgeon"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197709000-00011"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/ANA.0b013e3181d5e421"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/ANA.0b013e3181e16e14"},{"key":"e_1_2_6_40_1","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1136\/rapm-00115550-200807000-00009","article-title":"Comparison of regional anesthesia versus combined regional and general anesthesia for elective carotid endarterectomy: a small exploratory study","volume":"33","author":"Luchetti M","year":"2008","journal-title":"Regional Anesthesia and Pain Medicine"},{"key":"e_1_2_6_41_1","first-page":"202","article-title":"Anesthesia options in carotid endarterectomy","volume":"18","author":"Mrozek Z","year":"2007","journal-title":"Anesteziologie a Intenzivni Medicina"},{"key":"e_1_2_6_42_1","doi-asserted-by":"publisher","DOI":"10.1024\/0301-1526.35.4.232"},{"key":"e_1_2_6_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2004.03.010"},{"key":"e_1_2_6_44_1","first-page":"19","article-title":"Carotid endarterectomy surgery in cervical block: an economic alternative to general anaesthesia? [Karotisdesobliteration in cervicalisblockade: eine okonomische alternative zur vollnarkose?]","volume":"4","author":"Binder M","year":"1999","journal-title":"Gesundheits\u00f6konomie und Qualit\u00e4tsmanagement"},{"key":"e_1_2_6_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0741-5214(99)70185-0"},{"key":"e_1_2_6_46_1","first-page":"503","article-title":"Local versus general anaesthesia in carotid surgery. A prospective, randomised study","volume":"3","author":"Forssell C","year":"1989","journal-title":"European Journal of Vascular and Endovascular Surgery"},{"key":"e_1_2_6_47_1","doi-asserted-by":"publisher","DOI":"10.1097\/00008506-198903000-00007"},{"key":"e_1_2_6_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0750-7658(89)80138-8"},{"key":"e_1_2_6_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2009.05.011"},{"key":"e_1_2_6_50_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu304"},{"key":"e_1_2_6_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1993.tb07412.x"},{"key":"e_1_2_6_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aep012"},{"key":"e_1_2_6_53_1","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1177\/000313480006600708","article-title":"The influence of anesthetic technique on perioperative blood pressure control after carotid endarterectomy","volume":"66","author":"Eibes TA","year":"2000","journal-title":"American Surgeon"},{"key":"e_1_2_6_54_1","first-page":"1073","article-title":"Nitrous oxide\u2010induced increased homocysteine concentrations are associated with increased postoperative myocardial ischemia in patients undergoing carotid endarterectomy","volume":"91","author":"Badner NH","year":"2000","journal-title":"Anesthesia and Analgesia"},{"key":"e_1_2_6_55_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199309000-00005"},{"key":"e_1_2_6_56_1","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.bja.a013595"},{"key":"e_1_2_6_57_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-017-0315-7"}],"container-title":["Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fanae.14320","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.14320","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/anae.14320","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.14320","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T23:37:01Z","timestamp":1761694621000},"score":1,"resource":{"primary":{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1111\/anae.14320"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,31]]},"references-count":56,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1111\/anae.14320"],"URL":"https:\/\/doi.org\/10.1111\/anae.14320","archive":["Portico"],"relation":{},"ISSN":["0003-2409","1365-2044"],"issn-type":[{"value":"0003-2409","type":"print"},{"value":"1365-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,31]]},"assertion":[{"value":"2018-04-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-07-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}