Physiopathology of Intraoperative Visceral Ischemia and Anesthesiological Management of Supravisceral Aortic Clamping

Monaco, Fabrizio; Barucco, Gaia; Mattioli, Cristina; Monica, De Luca

doi:10.1007/978-3-319-94761-7_14

Cited by 3 publications

(1 citation statement)

References 105 publications

(150 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Hence, there is the need to limit the back-flow from the intercostal arteries by the rapid insertion of occlusive pegs, balloons, and tourniquets in the segmental vessels within the aorta. In particular, Griepp et al employed a method in which they clamp and divide the segmental vessels entering the aorta within the segment to be excised prior to cross-clamping or opening the aorta, which resulted in a 2% incidence of paraplegia [14] . As virtually all clinical approaches to thoracic and thoracoabdominal aneurysm resection unavoidably entail periods of cord ischemia, the importance of meticulous monitoring of perfusion variables has become crucial to ensure sufficient blood flow through the spinal cord collateral network.…”

Section: Spinal Cord Collateral Networkmentioning

confidence: 99%

A multimodal approach to prevent spinal cord ischemia in patients undergoing thoracoabdominal aortic aneurism repair - from pathophysiology to anesthesiological management

Monaco,

D'Andria Ursoleo,

Barucco

et al. 2023

Vessel Plus

Self Cite

View full text Add to dashboard Cite

Thoraco-abdominal aortic aneurysm (TAAA) open repair is a high-risk surgery further burdened with both mortality and morbidity. Despite numerous experimental endeavors and technical advancements, spinal cord ischemia (SCI) is still the most formidable morbidity to be resolved, irrespective of the open or endovascular surgical approach. It presents a spectrum of severity, ranging from temporary or permanent paraparesis to paraplegia with or without autonomic dysfunction. The timing of SCI occurrence is a crucial factor, with approximately 15% of cases manifesting intraoperatively, 50% within 48 h post-surgery, and the remaining 35% classified as late SCI, occurring more than 48 h after the procedure. The mechanism responsible for SCI is complex and multifactorial; hence, understanding its underlying pathophysiology is essential for its effective management. Over the last decade, strategies to enhance spinal cord perfusion and minimize the risk of SCI during TAAA open repair have been implemented. These include optimization of hemodynamics, hemoglobin levels, cardiac function, and cerebrospinal fluid pressure, ensuring collateral vascular network stability and distal aortic perfusion and intrathecal administration of drugs. A multimodal approach involving anesthesiologists and surgeons can lead to improved neurological recovery and a reduced incidence and severity of SCI.

show abstract

Section: Spinal Cord Collateral Networkmentioning

confidence: 99%

A multimodal approach to prevent spinal cord ischemia in patients undergoing thoracoabdominal aortic aneurism repair - from pathophysiology to anesthesiological management

Monaco,

D'Andria Ursoleo,

Barucco

et al. 2023

Vessel Plus

Self Cite

View full text Add to dashboard Cite

show abstract

Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries

et al. 2022

View full text Add to dashboard Cite

Early haemorrhage control and minimizing the time to definitive care have long been the cornerstones of therapy for patients exsanguinating from non-compressible haemorrhage (NCH) after penetrating injuries, as only basic treatment could be provided on scene. However, more recently, advanced on-scene treatments such as the transfusion of blood products, resuscitative thoracotomy (RT) and resuscitative endovascular balloon occlusion of the aorta (REBOA) have become available in a small number of pre-hospital critical care teams. Although these advanced techniques are included in the current traumatic cardiac arrest algorithm of the European Resuscitation Council (ERC), published in 2021, clear guidance on the practical application of these techniques in the pre-hospital setting is scarce. This paper provides a scoping review on how these advanced techniques can be incorporated into practice for the resuscitation of patients exsanguinating from NCH after penetrating injuries, based on available literature and the collective experience of several helicopter emergency medical services (HEMS) across Europe who have introduced these advanced resuscitation interventions into routine practice. Graphical Abstract

show abstract

Contemporary management of traumatic cardiac arrest and peri-arrest states: a narrative review

Carenzo,

Calgaro,

Rehn

et al. 2024

J Anesth Analg Crit Care

View full text Add to dashboard Cite

Trauma is a leading cause of death and disability worldwide across all age groups, with traumatic cardiac arrest (TCA) presenting a significant economic and societal burden due to the loss of productive life years. Despite TCA’s high mortality rate, recent evidence indicates that survival with good and moderate neurological recovery is possible. Successful resuscitation in TCA depends on the immediate and simultaneous treatment of reversible causes according to pre-established algorithms. The HOTT protocol, addressing hypovolaemia, oxygenation (hypoxia), tension pneumothorax, and cardiac tamponade, forms the foundation of TCA management. Advanced interventions, such as resuscitative thoracotomy and resuscitative endovascular balloon occlusion of the aorta (REBOA), further enhance treatment. Contemporary approaches also consider metabolic factors (e.g. hyperkalaemia, calcium imbalances) and hemostatic resuscitation. This narrative review explores the advanced management of TCA and peri-arrest states, discussing the epidemiology and pathophysiology of peri-arrest and TCA. It integrates classic TCA management strategies with the latest evidence and practical applications.

show abstract

Physiopathology of Intraoperative Visceral Ischemia and Anesthesiological Management of Supravisceral Aortic Clamping

Cited by 3 publications

References 105 publications

A multimodal approach to prevent spinal cord ischemia in patients undergoing thoracoabdominal aortic aneurism repair - from pathophysiology to anesthesiological management

A multimodal approach to prevent spinal cord ischemia in patients undergoing thoracoabdominal aortic aneurism repair - from pathophysiology to anesthesiological management

Advanced interventions in the pre-hospital resuscitation of patients with non-compressible haemorrhage after penetrating injuries

Contemporary management of traumatic cardiac arrest and peri-arrest states: a narrative review

Contact Info

Product

Resources

About