Anesthesia for Open Abdominal Aortic Surgery

Wozniak, Michael F; LaMuraglia, Glenn M.; Musch, Guido

doi:10.1097/01.aia.0000148886.63485.c3

Cited by 13 publications

(7 citation statements)

References 59 publications

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“…Open aneurysm repair requires general anesthesia, except in unusual circumstances, because of the required relaxation of the abdominal wall musculature and need for wide exposure of the aorta and its branches. 553 Insertion of monitoring lines before induction of anesthesia is appropriate if such monitoring devices improve the safety of induction. Infusion of an analgesic through an epidural catheter, by controlling pain fiber input, appears to lower the required dose of general anesthetic agents and may be associated with a shorter time to extubation.…”

Section: Anesthetic Considerations and Perioperative Managementmentioning

confidence: 99%

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

Chaikof

Dalman

Eskandari

et al. 2018

Journal of Vascular Surgery

1,989

1,478

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Important new recommendations are provided for the care of patients with an AAA, including suggestions to improve mutual decision-making between the treating physician and the patients and their families as well as a number of new strategies to enhance perioperative outcomes for patients undergoing elective and emergent repair. Areas of uncertainty are highlighted that would benefit from further investigation in addition to existing limitations in diagnostic tests, pharmacologic agents, intraoperative tools, and devices.

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Section: Anesthetic Considerations and Perioperative Managementmentioning

confidence: 99%

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

Chaikof

Dalman

Eskandari

et al. 2018

Journal of Vascular Surgery

1,989

1,478

View full text Add to dashboard Cite

show abstract

“…Except in unusual circumstances, open aneurysm repair requires general anesthesia, because of the required relaxation of the abdominal wall musculature. 369 Low doses of relaxing agents, such as a benzodiazepine plus an opiate, are recommended followed by conventional inhalation agent-based general endotracheal anesthesia. Insertion of monitoring lines prior to induction of anesthesia is appropriate if such monitoring devices improve the safety of induction.…”

Section: Choice Of Anesthetic Technique and Agentmentioning

confidence: 99%

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Chaikof

Brewster

Dalman

et al. 2009

Journal of Vascular Surgery

636

520

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DEFINITION OF THE PROBLEM Purpose of these guidelinesThe Clinical Practice Council of the Society for Vascular Surgery charged a writing committee with the task of updating practice guidelines, initally published in 2003, for surgeons and physicians who are involved in the preoperative, operative, and postoperative care of patients with abdominal aortic aneurysms (AAA). 1 This document provides recommendations for evaluating the patient, including risk of aneurysm rupture and associated medical co-morbidities, guidelines for selecting surgical or endovascular intervention, intraoperative strategies, perioperative care, long-term follow-up, and treatment of late complications.Decision making related to the care of patients with AAA is complex. Aneurysms present with varying risks of rupture and patient specific factors influence anticipated life expectancy, operative risk, and the need to intervene. Careful attention to the choice of operative strategy, as influenced by anatomic features of the AAA, along with optimal treatment of medical co-morbidities is critical to achieving excellent outcomes. Moreover, appropriate postoperative patient surveillance and timely intervention in the case of a late complication is necessary to minimize subsequent aneurysm-related death or morbidity. All of these clinical decisions are determined in an environment where cost-effectiveness will ultimately dictate the ability to provide optimal care to the largest possible segment of the population. Currently available clinical data sets have been reviewed in formulating these recommendations. However, an important goal of this document is to clearly identify those areas where further clinical research is necessary. Methodology and evidenceA comprehensive review of the available clinical evidence in the literature was conducted in order to generate a concise set of recommendations. The strength of any given recommendation and the quality of evidence was scored based on the GRADE system (Table I). 2 When the benefits of an intervention outweighed its risks, or, alternatively, risks outweighed benefits, a strong recommendation was noted. However, if benefits and risks were less certain, either because of low quality evidence or because high quality evidence suggests benefits and risks are closely balanced, a weak recommendation was recorded. The quality of evidence that formed the basis of these recommendations was scored as high, moderate, or low. Not all randomized controlled trials are alike and limitations may compromise the quality of their evidence. In addition, if there is a large magnitude of effect, the quality of evidence derived from observational studies may be high. Thus, quality of evidence was scored as high when additional research is considered very unlikely to change confidence in the estimate of effect; moderate when further research is likely to have an important impact in the estimate of effect; or low when further research is very likely to change the estimate of the effect.

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“…[5] Precautionary measures employed are discontinuation of vasodilators and inhalation anesthetics, preloading, gradual unclamping of the aorta and major vessels, and infusion of vasoconstrictors. [13] In our patient, ABP recovered rapidly after cross-clamp release, this could be related to 1) preloading, 2) preservation of responsive vasculature, and 3) unstressed myocardium during aortic clamping.…”

Section: Discussionmentioning

confidence: 50%

Infrarenal abdominal aortic aneurysm repair in presence of coronary artery disease: Optimization of myocardial stress by controlled phlebotomy

et al. 2009

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The repair of abdominal aortic aneurysm (AAA) in the presence of significant coronary artery disease (CAD) carries a high-risk of adverse peri-operative cardiac event. The options to reduce cardiac risk include perioperative beta-blockade, preoperative optimization by myocardial revascularization and simultaneous (combined) coronary artery bypass grafting and aneurysm repair. We describe intra-operative controlled phlebotomy to optimize myocardial stress during repair of infrarenal AAA in a patient with significant stable CAD.

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Anesthesia for Open Abdominal Aortic Surgery

Cited by 13 publications

References 59 publications

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

The care of patients with an abdominal aortic aneurysm: The Society for Vascular Surgery practice guidelines

Infrarenal abdominal aortic aneurysm repair in presence of coronary artery disease: Optimization of myocardial stress by controlled phlebotomy

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