Summary
Our technique of anaesthesia for resection of ventricular aneurysms is described, The haemodynamic changes which lead to decreased oxygen availability, increased oxygen consumption, and decreased cardiac output are kept in mind. Thiopentone, curare, and methoxyflurane are administered in doses which provide adequate anaesthesia and avoid myocardial irritability or depression. Careful attention is given to maintaining coronary dilatation and improving tissue perfusion by deliberate use of coronary vasodilators. Blood gases, pH, and electrolytes, especially potassium, are monitored and maintained within normal limits, both during operation and postoperatively. Pharmacological support and return to partial cardiopulmonary bypass employed when the heart function is inadequate, are also discussed. The importance of monitoring left atrial pressure and correlating it with central venous pressure and mean blood pressure is emphasized. Evaluation of the amount of transfusion, status of the myocardium, and the need for and the effectiveness of drug therapy are based on these observations. Postoperative arrhythmias are to be treated promptly and specifically. Prevention and management of postoperative respiratory complications are of the utmost importance.
Résumé
Nous décrivons notre technique ďanesthésie au cours de la résection ďanéurysme du ventricule; il faut toujours avoir à ľesprit les changements de ľhémodynamique qu’entraînent une diminution de la quantité ďoxygène disponible, une augmentation de la consommation ďoxygène et une diminution du débit cardiaque. Nous donnons du thiopentone, du curare et du méthoxyflurane à des doses adéquates pour éviter la dépression et ľirritabilité du myocarde. Nous faisons bien attention pour maintenir une dilatation des coronaires et améliorer la perfusion des tissus en utilisant des vasodilatateurs des coronaires. Durant ľopération et au cours des suites opératoires, nous surveillons et maintenons dans les limites de la normale les gaz du sang artériel, le PH et les électrolytes, plus spécialement le potassium. Nous discutons également du support pharmacologique et du retour éventuel à la circulation cardiopulmonaire extra corporelle partielle lorsque le cœur ne peut remplir sa fonction. Nous insistons sur ľimportance de surveiller la pression auriculaire gauche et de la tenir en correlation avec la pression veineuse centrale et la pression artérielle moyenne. C’est sur ces observations que nous basons la thérapie médicamenteuse, les quantités de sang à donner, ľétat du myocarde et ľefficacité de la thérapie. Ľarythmie post-opératoire fait ľobjet ďun traitement précoce et spécifique. La prévention des complications respiratoires post-opératoires et leur traitement éventuel sont des plus importants.
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Estafanous, F.G., Viljoen, J.F. & Loop, F.D. Anaesthesia for ventricular aneurysmectomy. Canad. Anaesth. Soc. J. 19, 160–172 (1972). https://doi.org/10.1007/BF03005046
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DOI: https://doi.org/10.1007/BF03005046