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Table 1 Anaesthesia protocols

From: GALA: an international multicentre randomised trial comparing general anaesthesia versus local anaesthesia for carotid surgery

General anaesthesia

Local anaesthesia

Premedication: benzodiazepine or none

Premedication: benzodiazepine or none

Intravenous access + arterial line under local anaesthetic

Intravenous access + arterial line under local anaesthetic

Intravenous induction + opiate analgesia

Judicious conscious sedation (e.g. benzodiazepine/opiate)

Muscle relaxant

Deep and superficial cervical plexus block + local infiltration (e.g. with bupivacaine)

Tracheal intubation, ventilation to normocapnia

Intra-operative top-up of local anaesthetic if required (lignocaine)

Maintain systemic blood pressure to pre-operative levels with intravenous fluids/cardioactive drugs if required

Maintain systemic blood pressures to pre-operative levels with intravenous fluids/cardioactive drugs if required

Reversal of anaesthetic and extubation

O2 as necessary by nasal cannulae/mask, in particular during cross-clamping of carotid vessels

Oxygen overnight by nasal cannulae/mask

 
  1. Each trial centre will continue with their standard anaesthesia protocol. Strict guidelines on anaesthetic management are unnecessary given that each surgical procedure is a 'package' of anaesthetic and surgical care. In general terms the anaesthesia protocols in this table should be used.