title: Anaesthesia for vascular emergencies.
abstract: Patients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower limb ischaemia have a high risk of peri-operative morbidity and mortality. Although anatomical suitability is not universal, endovascular surgery may improve mortality and the results of ongoing randomised controlled trials are awaited. Permissive hypotension pre-operatively should be the standard of care with the systolic blood pressure kept to 50-100 mmHg as long as consciousness is maintained. The benefit of local anaesthesia over general anaesthesia is not definitive and this decision should be tailored for a given patient and circumstance. Cerebrospinal fluid drainage for prevention of paraplegia is often impractical in the emergency setting and is not backed by strong evidence; however, it should be considered postoperatively if symptoms develop. We discuss the pertinent anaesthetic issues when a patient presents with a vascular emergency and the impact that endovascular repair has on anaesthetic management.
authors.affiliation: Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Ellard
authors.forename: G
authors.initials: G
authors.lastname: Djaiani
mesh_terms: D000758:Anesthesia; D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D004632:Emergency Medical Services / Q000379:methods*; D057510:Endovascular Procedures; D006801:Humans; D011182:Postoperative Care; D012421:Rupture / Q000601:surgery / Q000628:therapy; D014652:Vascular Diseases / Q000150:complications / Q000601:surgery*; D057772:Vascular System Injuries / Q000601:surgery / Q000628:therapy