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@article{808583,
author = {Lewis, S.C. and Warlow, C.P. and Bodenham, A.R. and Colam, B. and Rothwell, P.M. and Torgerson, D. and Dellagrammaticas, D. and Horrocks, M. and Liapis, C. and Banning, A.P. and Gough, M. and Gough, M.J. and Vlachovský, Robert and Staffa, Robert and Gregor, Zdeněk and Přívara, Mojmír and Goldemund, David and Pavlíková, Jana},
article_location = {London},
article_number = {dec 20},
keywords = {general anaesthesia; local anaesthesia; carotid surgery; trial},
language = {eng},
issn = {0140-6736},
journal = {Lancet},
title = {General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial},
volume = {372},
year = {2008}
}
TY - JOUR
ID - 808583
AU - Lewis, S.C. - Warlow, C.P. - Bodenham, A.R. - Colam, B. - Rothwell, P.M. - Torgerson, D. - Dellagrammaticas, D. - Horrocks, M. - Liapis, C. - Banning, A.P. - Gough, M. - Gough, M.J. - Vlachovský, Robert - Staffa, Robert - Gregor, Zdeněk - Přívara, Mojmír - Goldemund, David - Pavlíková, Jana
PY - 2008
TI - General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial
JF - Lancet
VL - 372
IS - dec 20
SP - 2132-2142
EP - 2132-2142
SN - 01406736
KW - general anaesthesia
KW - local anaesthesia
KW - carotid surgery
KW - trial
N2 - Background. The effect of carotid endarterectomy in lowering the risk of stroke ipsilateral to severe atherosclerotic carotid artery stenosis is offset by complications during or soon after surgery. We compared surgery under general anaesthesia with that under local anaesthesia because prediction and avoidance of perioperative strokes might be easier under local anaesthesia than under general anaesthesia. Methods. We undertook a parallel group, multicentre, randomised controlled trial of 3526 patients with symptomatic or asymptomatic carotid stenosis from 95 centres in 24 countries. Participants were randomly assigned to surgery under general (n=1753) or local (n=1773) anaesthesia between June, 1999 and October, 2007. The primary outcome was the proportion of patients with stroke (including retinal infarction), myocardial infarction, or death between randomisation and 30 days after surgery. Analysis was by intention to treat. The trial is registered with Current Control Trials number ISRCTN00525237. Findings. A primary outcome occurred in 84 (4.8%) patients assigned to surgery under general anaesthesia and 80 (4.5%) of those assigned to surgery under local anaesthesia; three events per 1000 treated were prevented with local anaesthesia (95% CI 11 to 17; risk ratio [RR] 0.94 [95% CI 0.70 to 1.27]). The two groups did not significantly differ for quality of life, length of hospital stay, or the primary outcome in the prespecified subgroups of age, contralateral carotid occlusion, and baseline surgical risk. Interpretation. We have not shown a definite difference in outcomes between general and local anaesthesia for karotid surgery. The anaesthetist and surgeon, in consultation with the patient, should decide which anaesthetic technique to use on an individual basis.
ER -
LEWIS, S.C., C.P. WARLOW, A.R. BODENHAM, B. COLAM, P.M. ROTHWELL, D. TORGERSON, D. DELLAGRAMMATICAS, M. HORROCKS, C. LIAPIS, A.P. BANNING, M. GOUGH, M.J. GOUGH, Robert VLACHOVSKÝ, Robert STAFFA, Zdeněk GREGOR, Mojmír PŘÍVARA, David GOLDEMUND a Jana PAVLÍKOVÁ. General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial. \textit{Lancet}. London, roč.~372, dec 20, s.~2132-2142. ISSN~0140-6736. 2008.
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