Awake sedation with propofol attenuates intraoperative stress of carotid endarterectomy in regional anesthesia

Abstract Background carotid endarterectomy in regional anesthesia is often associated with increased perioperative stress. We assumed, that carotid endarterectomy performed under awake sedation with propofol is more beneficial to prevent such stress than alprazolam premedication only. Methods A total of 47 consecutive patients with significant carotid artery stenosis were enrolled into this investigation and followed up to 5 years to explore vascular complications. All operations were performed in regional anesthesia. As premedication, all patients took 0.5 mg alprazolam 30 minutes before the procedure. After randomization 22 patients had awake sedation with target controlled propofol infusion, the other 25 had only premedication. Cortisol plasma levels were serially analysed: prior to surgery (T1), before (T2) and after release of carotid clamp (T3), at 2 (T4) and 24 post-operative hours (T5). Alprazolam levels were also measured before and after the surgery. Results The plasma concentration of cortisol was significantly lower in the propofol sedation group at T2 (P Conclusion An additional intraoperative propofol sedation provides better stress relief compared to alprazolam only premedication during awake carotid endarterectomy.