Table 4 PICO questions and recommendations
From: Anesthetic management of carotid endarterectomy: an update from Italian guidelines
Strength | LOE | |
|---|---|---|
PICO 1. In patient undergoing carotid endarterectomy (P), does local or locoregional anesthesia (I) compared to general anesthesia or to cooperative patient general anesthesia (C) improve the outcome (O)? | ||
Recommendation 1. In patient undergoing carotid endarterectomy, the free choice of regional anesthesia, or general anesthesia, or cooperative patient general anesthesia, is recommended, depending on the experience of the center, and patient’s preference and clinical status. | Strong for | 1++ |
Recommendation 2. In patient undergoing carotid endarterectomy, it is recommended to produce further, preferably multicenter studies, to estimate the preferences and relative degrees of patient satisfaction with regards to the type of anesthesia performed: regional anesthesia, general anesthesia or cooperative patient general anesthesia. | Recommendation for research | -- |
PICO 2. In patient undergoing carotid endarterectomy (P), does clinical neurological monitoring (I), compared to instrumental neurological monitoring (C), improve the outcome (O)? | ||
Recommendation 3. In patient undergoing carotid endarterectomy, clinical or instrumental cerebral intraoperative monitoring, chosen accordingly to the type of anesthesia and the temporary shunt strategy, is recommended. Nevertheless, clinical monitoring is more sensitive. | Strong for | 2+ |
Recommendation 4. In patient undergoing carotid endarterectomy, more than one instrumental monitoring method is suggested, as the association of techniques can increase the sensitivity compared to a single method. | GPP | -- |
PICO 3. In patient undergoing carotid endarterectomy (P) does heparin reversal with protamine at the end of the intervention (I), compared to no-reversal (C), improve the outcome (O)? | ||
Recommendation 5. Further studies, preferably multicenter, are recommended for patient undergoing carotid endarterectomy to assess whether intraoperative heparin reversal with protamine at the end of surgery could reduce bleeding complications without increasing the risk of thrombosis in the postoperative period. | Recommendation for research | -- |
PICO 4. In patient undergoing carotid endarterectomy (P) does postoperative blood pressure monitoring and following arterial hypertension treatment (I), compared to no monitoring (C), improve the outcome (O)? | ||
Recommendation 6. In patient undergoing carotid endarterectomy, postoperative blood pressure monitoring and the subsequent management of arterial hypertension is indicated, as it improves the outcome if compared with no blood pressure monitoring. | Weak for | 2− |