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Open Thoracoabdominal Aortic Aneurysm Repair

  • Helen A. Lindsay
  • Coimbatore SrinivasEmail author
  • Maral Ouzounian
Chapter

Abstract

Repair of a thoracoabdominal aortic aneurysm (TAAA) is among the most challenging cases for an anesthesiologist. The anesthetic technique is demanding and requires a high level of expertise, including proficiencies in managing one-lung ventilation, massive blood loss, coagulopathy, and cerebrospinal fluid drains. Specialized care from all members of the perioperative team has been shown to have a significant impact on outcomes.

The main complications include respiratory failure, renal failure, paraplegia, stroke, and major cardiac complications. To prevent spinal cord ischemia, different techniques may be used to achieve the same physiological goal of maintaining spinal cord perfusion pressure. Techniques to prevent and minimize spinal cord ischemia primarily focus on maximizing collateral flow by optimizing the spinal cord perfusion pressure while prolonging ischemic tolerance and reducing reperfusion injury with hypothermia and pharmacotherapy. The mainstay interventions to prevent renal injury include avoidance of nephrotoxic insults and selective cold renal perfusion.

Keywords

Thoracoabdominal aortic aneurysm Left heart bypass Spinal cord injury Cerebrospinal fluid drainage Renal protection 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Helen A. Lindsay
    • 1
  • Coimbatore Srinivas
    • 2
  • Maral Ouzounian
    • 3
  1. 1.Department of Anesthesia & Perioperative MedicineAuckland City HospitalAucklandNew Zealand
  2. 2.Department of AnesthesiaToronto General HospitalTorontoCanada
  3. 3.Division of Cardiovascular Surgery, Department of SurgeryToronto General HospitalTorontoCanada

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