Thoracoabdominal Aortic Aneurysm repair: What the anaesthetist should know?

Thoracoabdominal Aortic Aneurysm repair: What the anaesthetist should know? [Turk J Anaesthesiol Reanim]

Turk J Anaesthesiol Reanim. Ahead of Print: TARD-39129

Thoracoabdominal Aortic Aneurysm repair: What the anaesthetist should know?

Nitika Goel¹, Divya Jain¹, Ajay Savlania², Ashwani Bansal³
¹Department Of Anaesthesia, Pgimer, Chandigarh
²Department Of Vascular Surgery, Pgimer, Chandigarh
³Department Of Cardiothoracic And Vascular Surgery, Max Hospital, Chandigarh

Surgical repair of descending thoracic and thoracoabdominal aortic aneurysms (TAAAs) presents one of the greatest challenges for the anaesthesiologist. The challenge comes from the fine balance of complex medical issues in the setting of altered physiology that occurs during the perioperative period. Patients presenting for TAAA repair usually have multiple preexisting comorbid conditions involving their cardiac, pulmonary, and renal systems and aneurysm repair poses a direct and immediate threat to these systems in addition to the gastrointestinal and neurologic systems. Operative mortality in thoracoabdominal aortic surgery is quite high to the extent of 5-12% with a 5 year survival of 70-79% for descending thoracic aortic aneurysm and 59% for thoracoabdominal aortic aneurysm surgery. The complex haemodynamic changes associated with clamping and declamping of aorta requires thorough knowledge and expertise for the management of TAAA. We present a brief review on the anaesthetic management and possible complications which the anaesthetist should be aware of during TAAA repair.

Keywords: Thoracoabdominal aortic aneurysm, renal protection, spinal cord protection, one lung ventilation.

Torakoabdominal Aort Anevrizmas� onar�m�: Anestezistin bilmesi gerekenler nedir?

Nitika Goel¹, Divya Jain¹, Ajay Savlania², Ashwani Bansal³
¹Anestezi B�l�m�, Pgimer, Chandigarh
²Vask�ler Cerrahi Anabilim Dal�, Pgimer, Chandigarh
³Kalp ve Damar Cerrahisi Anabilim Dal�, Max Hastanesi, Chandigarh

�nen torasik ve torakoabdominal aort anevrizmalar�n�n (TAA) cerrahi onar�m� anestezist i�in en b�y�k zorluklardan birini sunmaktad�r. Zorluk, perioperatif d�nemde ortaya ��kan de�i�mi� fizyoloji ortam�nda karma��k t�bbi sorunlar�n dengesinden kaynaklanmaktad�r. TAAA onar�m� i�in ba�vuran hastalar genellikle kardiyak, pulmoner ve b�brek sistemlerini i�eren daha �nceden var olan komorbid durumlara sahiptir ve anevrizma onar�m�, gastrointestinal ve n�rolojik sistemlerin yan� s�ra bu sistemler i�in do�rudan ve acil bir tehdit olu�turmaktad�r. Torakoabdominal aort cerrahisinde operatif mortalite% 5-12 oran�nda, 5 y�ll�k sa� kal�m s�resi% 70-79, torakoral aort anevrizmas�% 59, torakoabdominal aort anevrizmas� cerrahisi i�in% 59'dur. Aort klemplenmesi ve deklampasyonu ile ili�kili kompleks hemodinamik de�i�iklikler, TAAA'n�n y�netimi i�in kapsaml� bilgi ve uzmanl�k gerektirir. Anestezistin TAAA onar�m� s�ras�nda bilmesi gereken anestezi y�netimi ve olas� komplikasyonlar� hakk�nda k�sa bir derleme sunuyoruz.

Anahtar Kelimeler: torakoabdominal aort anevrizmas�, renal koruma, omurilik korumas�, bir akci�er ventilasyonu.

Corresponding Author: Nitika Goel, India

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