Perioperative management of thoracic and thoracoabdominal aneurysms

Abstract

By reading this article, you should be able to:Distinguish the differences between true aneurysm, false aneurysm, and dissection. Explain the perioperative management of patients undergoing surgery involving the aortic arch and the descending aorta. Illustrate the physiological changes that occur during left heart bypass for descending thoracic aortic surgery. Describe the postoperative care of patients undergoing major aortic surgery and, in particular, the measures used to ensure maintenance of spinal cord perfusion.Thoracoabdominal aortic surgery is associated with high morbidity and mortality. An experienced team must work together to provide preoperative assessment, perioperative management, and postoperative care of the patient.

Cerebral Perfusion and Neuromonitoring during Complex Aortic Arch Surgery: A Narrative Review

“…As a matter of fact, effective neuromonitoring prevents negative consequences of a suboptimal cerebral perfusion [60,61].…”

Anesthetic Management of Surgical Repair of Descending Thoracic Aortic Aneurysm

“…Repair of DTA is associated with application of aortic cross-clamp. When a clamp is applied distal to the left subclavian artery, the use of proximal and distal aortic perfusion methods is preferable both to alleviate the raised left ventricular afterload and to maintain perfusion to all body organs [9].…”

“…b) Examination for evidence of compression of adjacent structures. Stridor or dyspnea indicates encroachment on the trachea or left main bronchus; dysphagia indicates esophageal compression; hoarseness is caused by stretching of the recurrent laryngeal nerve.c)Baseline neurological examination and recording of any neurological deficit[9].…”