[Preparation of the patient for reconstructive surgery of the abdominal aorta as an element in prevention of perioperative complications].
The tasks of an anesthetist in preoperative preparation of the patients submitted for reconstructive surgery of the abdominal aorta have been the subject of this paper. These tasks thought as an element of prevention of perioperative complications have been preceded by the description of characteristic of this steadily increasing population of patients with aortic abdominal aneurysm, or obliterative atheromatosis of the abdominal aorta (syndrome Leriche). There is a justified need for elective surgery in this population of patients because of the following premises: a substantial minor perioperative mortality (about 3% now) in the cases of aortic aneurysms, the steady high mortality in emergency operations and difficulty to foresee the dynamics in enlarging of aortic aneurysms, as well as the risk of their rupture. An elective surgery in Leriche syndrome decreases probability of splanchnic perioperative complications because of bowel ischaemia. Hypertension and ischaemic heart disease are detected in about 50% of described population and they comprise also the premises for perioperative complications in this group of patients. The risk of such a complications results also from clamping and declamping of the aorta, the necessary stages of aortic abdominal surgery. Characteristic pattern of described population and the pathomechanisms of perioperative complications call for precise and complex preoperative evaluation of these patients. Preoperative evaluation has been contemporary defined as a clinic of preoperative appraisal because of its importance. In elective procedures this clinic embraces two stages: prehospital and hospital. In both an anesthetist should play an integrative role in the activities of interdisciplinary team which prepares the patients for surgery. The peculiar task in this team belongs to the cardiologist, whose experience should also embrace the problems of surgical patients. The tasks of an anesthetic team in emergency concerning aortic surgery have been exposed in this paper. A proper understanding by anaesthetist of his/her role as an integrator of interdisciplinary team in perioperative stage of surgical disease is a new task for young doctors as well as for their teachers.
Szulc
R
R
Katedra Anestezjologii i Intensywnej Terapii i Klinika Anestezjologii i Intensywnej Terapii ul. Długa 1/2, 61-848 Poznań. roman_szulc@poczta.onet.pl
D000368:Aged; D000758:Anesthesia / Q000379:methods; D001012:Aorta, Abdominal / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000601:surgery*; D001161:Arteriosclerosis / Q000601:surgery; D005260:Female; D006801:Humans; D007925:Leriche Syndrome / Q000601:surgery; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods