Anesthetic consideration for descending thoracic aortic aneurysm repair.
Anesthesia for surgery of the aorta poses some of the most difficult challenges for anesthesiologists. Major hemodynamic and physiologic stresses and sophisticated techniques of extracorporeal support are superimposed on patients with complex medical disease states. In this review, etiologies, natural history, and surgical techniques of thoracic aortic aneurysm are presented. Anesthetic considerations are discussed in detail, including the management of distal perfusion using partial cardiopulmonary bypass. Considerations of spinal cord protection, including management of proximal hypertension, cerebral spinal fluid drainage, and pharmacological therapies, are presented.
Kahn
Ronald A
RA
Department of Anesthesiology, the Mount Sinai School of Medicine, New York, New York 10029-6547, USA. ron.kahn@mssm.edu
Stone
Marc E
ME
Moskowitz
David M
DM
D000758:Anesthesia; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000601:surgery*; D001794:Blood Pressure / Q000502:physiology; D006348:Cardiac Surgical Procedures; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D003250:Constriction; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007674:Kidney Diseases / Q000517:prevention & control; D008353:Mannitol / Q000627:therapeutic use; D011300:Preoperative Care; D013116:Spinal Cord / Q000098:blood supply; D013118:Spinal Cord Diseases / Q000517:prevention & control; D013256:Steroids / Q000627:therapeutic use
D013256:Steroids; D008353:Mannitol