Table of Contents
ISRN Stroke
Volume 2012 (2012), Article ID 562184, 4 pages
Clinical Study

Anaesthesia during Carotid Endarterectomy and Urinary Neopterin

1Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
2Research Institute of Health Science, Chiang Mai University, Chiang Mai 50200, Thailand
3Department of Vascular Surgery, University Hospital Southampton, University of Southampton, Southampton SO16 6YD, UK

Received 11 July 2012; Accepted 6 September 2012

Academic Editors: C. M. Loftus and J. Van Der Grond

Copyright © 2012 K. Rerkasem and C. P. Shearman. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Recent systematic reviews of randomized controlled trials show that the rate of postoperative complications after carotid endarterectomy (CEA) was not significantly different between operations performed under general anesthesia (GA) or local anesthesia (LA). However, these studies were not large enough to draw meaningful conclusions about any difference in mortality. This study therefore aimed to compare a surrogate endpoint of postoperative mortality between GA and LA by using urinary neopterin. 68 consecutive patients admitted electively for CEA were studied. Urinary neopterin levels were assayed preoperatively, immediately postoperatively (PO), 4, 6, 12, and 24 hrs PO. This study compared the level of urinary neopterin between GA and LA. Of the 68 CEAs, 48 operations were performed under GA. Urinary neopterin concentration in LA group increased PO and reached a peak at 6 hrs PO. At this point, the urinary neopterin levels in the GA group (85.3 μmol/mol creatinine) were significantly lower than those under the LA group (123.4 μmol/mol creatinine) ( ). We found that the level of urinary neopterin level after operation in LA was significantly higher than those under GA. More studies are needed.