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Anesthesia for Aortic Surgery

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Anesthesiology

Abstract

Diseases of the aorta requiring surgical intervention can be some of the most complex cases the anesthesiologist can be called upon to manage. Many factors influence the anesthetic management of these cases. The anatomic location of the dissection or aneurysm must be considered when planning the type and location of invasive monitors. The surgical plan can require deep hypothermic circulatory arrest (DHCA), single lung ventilation or other specialized techniques. This chapter will briefly review the disease states and surgical treatments of thoracic aortic dissections and aneurysms, followed with the anesthetic management of these cases.

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References

  1. The Gale encyclopedia of medicine. 3rd ed. Stamford, CT; 2008.

    Google Scholar 

  2. Patel PD, Arora RR. Pathophysiology, diagnosis, and management of aortic dissection. Ther Adv Cardiovasc Dis. 2008;2(6):439–68.

    Article  PubMed  Google Scholar 

  3. Ramanath VS, Oh JK, Sundt TM, Eagle KA. Acute aortic syndromes and thoracic aortic aneurysm. Mayo Clin Proc. 2009;84(5):465–81.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245.

    Article  PubMed  Google Scholar 

  5. DeBakey ME, Henly WS, et al. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg. 1965;49:131.

    Google Scholar 

  6. Miller DC, Stinson EB, et al. Aortic dissections. J Thorac Cardiovasc Surg. 1979;78:367.

    Google Scholar 

  7. Ince H, Nienaber CA. Diagnosis and management of patients with aortic dissection. Heart. 2007;93:266–70.

    Article  PubMed  PubMed Central  Google Scholar 

  8. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/019734s017lbl.pdf.

  9. https://chiesiusa.com/wp-content/uploads/Cleviprex-us-prescribing-information-nov-fda-approved.pdf.

  10. Meretoja OA, Laaksonen VO. Hemodynamic effects of preload and sodium nitroprusside in patients subjected to coronary artery bypass grafting. Circulation. 1978;58:815–25.

    Article  CAS  PubMed  Google Scholar 

  11. Hanke AA, Dellweg C, Schöchl H, Weber CF, Jüttner B, Johanning K, Görlinger K, Rahe-Meyer N, Kienbaum P. Potential of whole blood coagulation reconstitution by desmopressin and fibrinogen under conditions of hypothermia and acidosis—an in vitro study using rotation thrombelastometry. Scand J Clin Lab Invest. 2011;71:292–8.

    Article  CAS  PubMed  Google Scholar 

  12. Hanke AA, Dellweg C, Kienbaum P, Weber CF, Görlinger K, Rahe-Meyer N. Effects of desmopressin on platelet function under conditions of hypothermia and acidosis: an in vitro study using multiple electrode aggregometry. Anaesthesia. 2010;65:688–91.

    Article  CAS  PubMed  Google Scholar 

  13. Chatterjee K. The Swan-Ganz catheters: past, present, and future. A viewpoint. Circulation. 2009;119(1):147–52.

    Article  PubMed  Google Scholar 

  14. Grigore AM, Grocott HP, Mathew JP, Phillips-Bute B, Stanley TO, Butler A, Landolfo KP, Reves JG, Blumenthal JA, Newman MF. The rewarming rate and increased peak temperature alter neurocognitive outcome after cardiac surgery. Anesth Analg. 2002;94:4–10.

    PubMed  Google Scholar 

  15. Nathan HJ, Wells GA, Munson JL, Wozny D. Neuroprotective effect of mild hhypothermia in patients undergoing coronary artery surgery with cardiopulmonary bypass: a randomized trial. Circulation. 2001;104:I85–91.

    Article  CAS  PubMed  Google Scholar 

  16. Stecker MM, Cheung AT, Pochettino A, Kent GP, Patterson T, Weiss SJ, Bavaria JE. Deep hypothermic circulatory arrest: Effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg. 2001;71(1):14–21.

    Article  CAS  PubMed  Google Scholar 

  17. Vretzakis G, et al. Cerebral oximetry in cardiac anesthesia. J Thorac Dis. 2014;6(Suppl 1):S60–9.

    PubMed  PubMed Central  Google Scholar 

  18. Greenberg RK, Lu Q, Roselli LG, et al. Contemporary analysis of descending thoracic and thoracoabdominal aneurysm repair. A comparison of endovascular and open techniques. Circulation. 2008;118:808–17.

    Article  PubMed  Google Scholar 

  19. Cheung AT, Weiss SJ, McGarvey ML, et al. Interventions for reversing delayed onset postoperative paraplegia after thoracic aortic reconstruction. Ann Thorac Surg. 2002;74:413–9.

    Article  PubMed  Google Scholar 

  20. Guerit JM, Witdoeckt C, Verhelst R, Matta AJ, Jacquet LM, Dion RA. Sensitivity, specificity and surgical impact of somatosensory evoked potentials in descending aortic surgery. Ann Thorac Surg. 1999;67(6):1943.

    Article  CAS  PubMed  Google Scholar 

  21. Black JH, Davison JK, Cambria RP. Regional hypothermia with epidural cooling for prevention of spinal cord ischemic complications after thoracoabdominal aortic surgery. Sem Thorac Cardiovasc Surg. 2003;15:345–52.

    Article  Google Scholar 

  22. Yan TD, Bannon PG, Bavaria J, Coselli JS, Elefteriades JA, Griepp RB, et al. Consensus on hypothermia in aortic arch surgery. Ann Cardiothorac Surg. 2013;2:163–8.

    PubMed  PubMed Central  Google Scholar 

  23. Sugiura T, Imoto K, Uchida K, Minami T, Yasuda S. Comparative study of brain protection in ascending aorta replacement for acute type A aortic dissection: retrograde cerebral perfusion versus selective antegrade cerebral perfusion. Gen Thorac Cardiovasc Surg. 2012;60:645–8.

    Article  PubMed  Google Scholar 

  24. Gelman S. The pathophysiology of aortic cross clamping and unclamping. Anesthesiology. 1995;82:1026–60.

    Article  CAS  PubMed  Google Scholar 

  25. Laschinger JC, Cunningham JN, Cooper MM, Krieger K, Nathan IM, Spencer FC. Prevention of ischemic spinal cord injury following aortic cross-clamping: use of corticosteroids. Ann Thorac Surg. 1984;38:500–7.

    Article  CAS  PubMed  Google Scholar 

  26. Galandiuk S, Rapue G, Appel S, Polk HC. The two-edged sword of large does steroids for spinal cord trauma. Ann Surg. 1993;218:419–27.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Outtara A, Lecomte P, Le Manach Y, et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology. 2005;103(4):687–94.

    Article  Google Scholar 

  28. Qaseem A, Humphrey LL, Chou R, Snow V, Shekelle P. Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2011;154(4):260–7.

    Article  PubMed  Google Scholar 

  29. Nylander WA Jr, Plunkett RJ, Hammon JW Jr, Oldfield EH, Meacham WF. Thiopental modification of ischemic spinal cord injury in the dog. Ann Thorac Surg. 1982;33:64–8.

    Article  PubMed  Google Scholar 

  30. Stone JG, Young WL, Marans ZS, et al. Consequences of electroencephalographic-suppressive doses of propofol in conjunction with deep hypothermic circulatory arrest. Anesthesiology. 1996;85:497–501.

    Article  CAS  PubMed  Google Scholar 

  31. Acher CW, Wynn MM, Hoch JR, Popic P, Archibald J, Archibald J, et al. Combined use of cerebral spinal fluid drainage and naloxone reduces the risk of paraplegia in thoracoabdominal aortic aneurysm repair. J Vasc Surg. 1994;19:236–48.

    Article  CAS  PubMed  Google Scholar 

  32. Cooper DM, et al. Bicarbonate does not improve hemodynamics in critically III patients who have lactic acidosis: a prospective, controlled clinical study. AIM. 1990;112:492.

    CAS  Google Scholar 

  33. Surgenor SD, et al. Intraoperative red blood cell transfusion during coronary artery bypass graft surgery increases the risk of postoperative low-output heart failure. Circulation. 2006;114(1S):I43–8.

    PubMed  Google Scholar 

  34. Edwards MS, Andrews JS, Edwards AF, et al. Results of endovascular aortic aneurysm repair with general, regional, and local/monitored anesthesia care in the American College of Surgeons National Surgical Quality Improvement Program database. J Vasc Surg. 2011;54:1273–82.

    Article  PubMed  PubMed Central  Google Scholar 

  35. American College of Radiology. ACR appropriate criteria for acute chest pain—suspected aortic dissection. https://acsearch.acr.org/docs/69402/Narrative/.

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Correspondence to Michael Stuart Green D.O., M.B.A. .

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DeAngelis, M.C., Green, M.S. (2018). Anesthesia for Aortic Surgery. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_9

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  • DOI: https://doi.org/10.1007/978-3-319-74766-8_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74765-1

  • Online ISBN: 978-3-319-74766-8

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