RT Book, Section
A1 Nishanian, Ervant
A1 Shaefi, Shahzad
A2 Atchabahian, Arthur
A2 Gupta, Ruchir
SR Print(0)
ID 57261762
T1 Chapter 91. Thoracoabdominal Aneurysm
T2 The Anesthesia Guide
YR 2013
FD 2013
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-176049-2
LK accessanesthesiology.mhmedical.com/content.aspx?aid=57261762
RD 2024/04/23
AB Often  associated  with  HTN,  atherosclerosis,  and  connective  tissue  disorders  such  as  Marfan  syndromeBest  surgical  series  has  10%  mortalityHigh  risk  of  rupture  along  with  aortic  dissection.  Untreated  aortic  dissection  carries  a  25–35%  mortality  within  the  first  few  daysComorbiditiesPVDCADHTNChronic  obstructive  pulmonary  disease  (COPD)  (smokers)Renal  impairment  (independent  predictor  of  postop  renal  failure  and  mortality)Anticipate  potential  for  rapid  large  blood  loss  and  hemodynamic  shifts.  Successful  outcome  requires  maintenance  of  adequate  cardiac  output  and  flow  to  vital  organs  including  the  spinal  cord  while  avoiding  hypertension  and  aortic  ruptureRisk  of  paraplegia  ≥3.5%  blood  as  supply  to  the  anterior  spinal  artery  involved.  Techniques  to  reduce  incidence  of  paraplegia  include:  Epidural  cooling  of  the  spinal  cord  during  surgeryCerebrospinal  fluid  drainageReimplantation  of  intercostal  arteriesSSEP  monitoringProvision  of  distal  aortic  perfusion  during  surgery  with  the  use  of  atriofemoral  (left  atrium)  bypass  to  the  distal  aortaEndovascular  repairs  are  possible  in  patients  that  have  appropriate  anatomy.  However,  be  prepared  to  convert  to  open  procedure