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Lancet. 2008 Dec 20;372(9656):2132-42. doi: 10.1016/S0140-6736(08)61699-2. Epub 2008 Nov 27.

General anaesthesia versus local anaesthesia for carotid surgery (GALA): a multicentre, randomised controlled trial.

Collaborators (684)

Colam B, Fraser A, Grant S, Hunter J, Leigh-Brown A, Lewis SC, Paterson M, Soosay V, Young A, Warlow CP, Williamson A, Dean Z, Mazzoli T, Ricci S, Valenti D, Bamford J, Beard J, Dearden M, Murray G, Ruckley V, Norman PE, Sedivy P, Idla A, Schmitz-Rixen T, Maritati G, Banning AP, Bodenham A, Colam B, Dellagrammaticas D, Gough M, Gough MJ, Horrocks M, Lewis SC, Liapis C, Rothwell PM, Torgerson D, Warlow CP, Cokic N, Doppler W, Hlatky P, Koelblinger C, Raith C, Zölss C, Dimmitt S, Gharbi R, Hankey G, Maden A, Mwipatayi BP, Sieunarine K, Tan A, Turner G, Wesseldine A, Davis TM, Norman PE, Audzei P, Davidovski I, Dedul D, Hetsiuk A, Kornievich S, Gao J, Huang YG, Jing G, Li H, Li YJ, Liu B, Liu CW, Wu JD, Ye W, Yu CH, Ban T, Buljan K, Candrlic K, Dapic D, Ilijasevic M, Istvanic T, Kovac B, Kvolik S, Lehner V, Pinotic K, Hudorović N, Ivanec Z, Lovricević I, Mazul-Sunko B, Novotny Z, De Syo D, Vuković V, Biebl O, Dolecek L, El Samman C, Kalasova H, Kubricht V, Matous P, Michalek P, Sedivy P, Stajnrt M, Stern M, Svec M, Vitasek P, Vrzal J, Weiss K, Janousek L, Kieslichova E, Mazarova V, Piza P, Vychodil P, Dulovcova V, Fiksa J, Hruby J, Maresch M, Mathias M, Rubes D, Tosenovsky P, Vidim T, Henzl M, Riman J, Ziegler Z, Drabek P, Hrbac T, Reguli S, Stigler J, Bachleda P, Drac P, Hudecek M, Koutna J, Sanak D, Utikal P, Goldemund D, Gregor Z, Pavlikova J, Podlaha J, Privara M, Staffa R, Vlachovsky R, Barankova L, Chlouba V, Fiedler J, Prazak P, Priban V, Wierer A, Ellervee T, Järve H, Sell A, Taba P, Idla A, Kolbassov V, Kullamaa S, Paavel T, Abramishvili N, Bokuchava M, Kachapuridze N, Kipiani K, Papashvili K, Pargalava N, Adili F, Dietz A, Neidhart G, Nentwig G, Schmitz-Rixen T, Sitzer OM, Beno M, Essink-Hassels M, Lander K, Ruemenapf G, Breuer P, Heldt R, Melichar G, Rieper J, Eckstein HH, Poppert H, Schneider G, Andrikopoulos V, Angel A, Bakogiannis K, Dermitzaki M, Georgakis P, Lioupis C, Maras D, Moulakakis KG, Sfyroeras G, Arato E, Gyevnar Z, Hardi P, Kasza G, Kollar L, Menyhei G, Pal E, Sinay L, Verzar Z, Volgyi E, Elmakias SS, Harah E, Kristal K, Lebi D, Leonty Y, Levy D, Milo R, Yoffe B, Bissi M, Cappellini B, Cassamali T, Corino L, Denkewitz T, Ghilardi G, Massetto N, Di Mauro P, Tommasino C, Bartolucci R, Buffa V, Corsi FM, D'Avino E, Di Cesare F, Di Pirro L, Lappa A, Luzzi S, Maritati G, Menichetti A, Nesi F, Pannone A, Picozzi P, Pogany G, Rabitti G, Severi L, Avella R, Biandolino P, Giomarelli PP, Monfregola MR, Palasciano G, Peccianti V, Pieragalli D, Setacci C, Setacci F, Sirignano P, Bordoni M, Casadei V, Cugnasca M, De Troia A, Geremia L, Guffanti P, Lo Guercio G, Maniaci MV, Mauri, Morbidelli A, Aletta A, Costanzo E, D'Arrigo G, Di Stefano F, Lomeo A, Maugeri S, Monea MC, Scardavilli G, Scolaro A, Aloisi P, Ciccozzi A, Manno M, Marrelli A, Martinazzo C, Mastromarino A, Petrassi C, Piroli A, Spartera C, Ventura M, Alessandrini F, Carissimi C, Centritto EM, Cinelli G, De Filippo C, Liberatoscioli G, Modugno P, Rossi M, Attanzio MT, Bajardi G, Bellisi M, Machi P, Salemi S, Savettieri G, Crea MA, di Lazzaro V, Ferrante A, Guarneri S, Manni R, Snider F, Stefanuto C, Berardi G, Bianchi A, Comis M, Cumbo P, Fadde M, Ferrero E, Ferri M, Filardo A, Gaggiano A, Ganzaroli M, Labate C, Maggio D, Mennuti G, Minicucci S, Musso A, Nessi F, Pasquino M, Perretta L, Piazza S, Verdecchia C, Viazzo A, Antico A, Battan E, Ciarlo M, Giardini G, Luca Iob G, Marinello C, Piccolo D, Bove R, Castrucci T, Lorido A, Sammarco S, Bruzzone B, Cannata D, Colotto P, Finocchi C, Giudici N, Mambrini S, Mazzei R, Palombo D, Pellegrino A, Rousas N, Viacava A, Ermirio D, Faga D, Simoni G, Benedetti-Valentini F, Gabrielli R, Garofano R, Gossetti B, Guerricchio R, Irace L, Lenzi G, Gedins M, Kisis K, Krievins D, Krustina I, Lietuvietis E, Malina M, Morlata N, Rits J, Thor S, Ivanova P, Kikule I, Liepa V, Ligers A, Stengrevica N, Vnukova N, Zvirgzdins V, Brouwers PJ, Geelkerken RH, Stam A, Simon MA, den Hoed PT, Oltmans M, Rettig H, Veen HF, Zuidgeest D, Feldo M, Kesik J, Kobusiewicz W, Łatkiewicz D, Myślinski W, Przywara S, Terlecki P, Wroński J, Zubilewicz T, Alfonso G, Azevedo E, de Albuquerque R, Mansilha A, Al-Salman M, Aldaif AK, Alnasr TA, El Dawlatly AA, Elkayali A, Rabee HM, Chudikova E, Chudá I, Dulka T, Goldenberg Z, Lofaj P, Pavlikova M, Pisar M, Sefranek V, Slysko R, Tomka J, Tóthová Z, Zita Z, Cairols MA, Iborra E, Mercadal M, Rubio F, Canovas D, Cobo L, Gimenez-Gaibar A, Gonzalez E, Gonzalo B, Guilera N, Hospedales J, Laso MJ, Perez J, Solanich T, Hensater M, Karlström L, Kjällman L, Rosengren L, Ewaldsson CA, Gillgren P, Käll TB, Konrad P, Lindkvist M, Nilsson L, Takolander R, von Zweigbergk E, Cinar B, Coruh T, Kurc E, Ozsoy D, Sargin M, Tutkavul K, Yekeler I, Aksoy M, Aksoy S, Kurtoglu M, Arar C, Canbaz S, Celik Y, Ege T, Ketenc S, Sunar H, Unal S, Asik I, Bengisun U, Koksoy C, Yucemen N, Bamford J, Berridge DC, Bodenham AR, Caldicott L, Cooper J, Cross M, Ford H, Fuller R, Gamlin F, Gough M, Gough MJ, Homer-Vanniasinkum S, Howell S, Kent P, Lumb A, Mavor AI, Scott DJ, Shah M, Wanklyn P, Budd JS, Horrocks M, McAteer P, Shaw L, Dewar R, Lewis MH, Potter C, Richards H, Roberts R, Townsend E, Wagle A, Woodford P, Hall G, Holdsworth R, Macleod M, Michels L, Sandercock PA, Sudlow C, Warlow CP, Woods A, Abraham JS, Bukhari M, Bush A, Calvey J, Chadwick I, Krishnaprasad K, Oldham T, Tomlinson M, Vickers A, Wilson D, Wilson P, Greystone S, Grocott EC, Hayes W, Haynes S, Jenkins C, Jenkins D, Moore W, Nyamekye I, Overstall P, Riseboro S, Williams H, Boyle J, Duane D, Gaunt M, Kirkpatrick PJ, Martin P, Risdall JE, Scurrah N, Turner CL, Varty K, Ferguson IT, Horsfall S, Mitchell DC, Robinson S, Frankel J, Morris GE, Phillips M, Sansome A, Sparkes DJ, Williams J, Ashton W, Baker S, Clark M, Darke SG, Dunnill R, Hargreaves M, Jenkinson D, Thomson C, White N, Wijesinghe LD, Bapat P, Barrett JA, Blair SD, Chandrasekar R, Lawrence G, Lowe D, Sangster G, Smith M, Van Miert M, Das SK, Malik O, Nel M, Rakowicz W, Aukett M, Carmichael M, Colchester A, Taylor PR, Wood C, Ageed A, Boom SJ, Ghosh S, Godfrey J, Hewitt-Gray J, McDiarmid I, Yousif S, Ziarkowski A, Al-Din A, Carpenter M, Ch'ng K, Curley PJ, Davey R, Henderson B, Hossain JF, Irvine CD, Loizou L, Main A, Stanners A, Muldoon T, Soong CV, Wiggam I, Armon MP, Burrows M, Holmes L, Metcalf AK, Nunn D, Abdul-Hamid A, Akomalafe B, Bryce J, Chetter I, Samaan A, Briley D, Collin J, Darby C, Dobson M, Foex P, Grange C, Handa A, Hands L, Higham HE, Perkins JM, Rothwell PM, Sear J, Stoneham M, Hamilton G, Judge C, Morris-Vincent P, Pegg M, Wilson LA, Aldoori MI, Dafalla BE, Kumar N, Hay IF, Jefferson P, Muir I, Peel W, Rutherford J, Sathianathan J, Wight S, Williams D, Wrathall W, Bachoo P, Brittenden J, Counsell C, Patey R, Read J, de Cossart L, Dimitri SK, Edwards P, Fergusson N, Jameson P, Somauroo J, Taylor V, Aravindan PD, Brocklehurst I, Mirza S, Namushi RN, Oshodi TO, Ruff D, Solomon SA, Vassallo J, Egbe M, Halstead G, Onwudike M, Putland A, Roberts N, Salaman RA, Watson D, Caine S, Day J, Lamont P, Murphy PJ, Smith F, Beacham K, Dorman PJ, Lambert D, Rodgers H, Collas D, Sarin S, Shah J, Baht HS, Banks J, Cowie L, Gunathilagan G, Hargroves D, Insall R, Smithard DG, Chadha DK, Pillay WR, Rashid J, Sayles J, Hill S, Lawton G, Lloyd CM, Marsh A, Clarke G, Lonsdale RJ, Venables G, Cross R, Lord B, McIlmoyle J, Osman HY, Robinson J, Chant H, Mate A, Sim D, Upton P, Thomas D, Wolfe JH, McCollum C, O'Neill P, Bernatsky V, Bondar L, Karpenko A, Mamonova M, Muz N, Yavorsky V.

Author information

  • 1Neurosciences Trials Unit, Division of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK. steff.lewis@ed.ac.uk

Abstract

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 carotid surgery. The anaesthetist and surgeon, in consultation with the patient, should decide which anaesthetic technique to use on an individual basis.

FUNDING:

The Health Foundation (UK) and European Society of Vascular Surgery.

Comment in

PMID:
19041130
[PubMed - indexed for MEDLINE]
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