Awake aortic aneurysm repair in patients with severe pulmonary disease.
BACKGROUND
We report the use of retroperitoneal aortic aneurysm repair utilizing exclusive regional anesthesia (no intubation or inhalation anesthetic) in high pulmonary risk patients.


METHODS
Six patients were retrospectively reviewed. Pulmonary disease was diagnosed by clinical history and pulmonary function tests. Patients received intravenous sedation and regional anesthesia. Retroperitoneal aortoiliac aneurysm repair was performed.


RESULTS
All patients used inhaled steroids and albuterol. Three required theophylline and home oxygen. FEV1 = 23% +/- 5% predicted, FVC = 34% +/- 5% predicted, and PO2 = 62 +/- 2 mm Hg. Operative time was 247 +/- 25 minutes. Blood loss was 840 +/- 479 mL. Five of six patients (83%) tolerated awake aneurysm repair and had intensive care unit stays of 2.4 +/- 0.6 days, and postoperative hospital stays of 8.2 +/- 1.8 days. One patient was converted to general anesthesia and had a prolonged hospital stay.


CONCLUSIONS
With thorough patient communication, awake retroperitoneal aortic aneurysm repair can be safely performed in select patients with severe pulmonary disease.
McGregor
W E
WE
Department of Surgery, Northside Medical Center/Forum Health, Northeastern Ohio Universities College of Medicine, Youngstown 44501, USA.
Koler
A J
AJ
Labat
G C
GC
Perni
V
V
Hirko
M K
MK
Rubin
J R
JR
D000280:Administration, Inhalation; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000771:Anesthesia, Intravenous; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D016063:Blood Loss, Surgical; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003243:Consciousness; D003422:Critical Care; D005541:Forced Expiratory Volume / Q000502:physiology; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D017543:Iliac Aneurysm / Q000601:surgery*; D007902:Length of Stay; D008171:Lung Diseases / Q000150:complications* / Q000188:drug therapy / Q000628:therapy; D010102:Oxygen Inhalation Therapy; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use; D013806:Theophylline / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors; D014797:Vital Capacity / Q000502:physiology
D001993:Bronchodilator Agents; D006993:Hypnotics and Sedatives; D013256:Steroids; D013806:Theophylline; D000420:Albuterol