title: Anesthetic management of descending thoracic aortobifemoral bypass for aortoiliac occlusive disease: Our experience.
abstract: BACKGROUND
  Complete obstruction of the abdominal aorta at the renal artery level is a difficult surgical problem. Aortic clamping and declamping can lead to profound haemodynamic changes, myocardial infarction, ventricular failure or even death may result. These complications are important challenges in anesthetic management of these patients.
  
  
  METHODS
  Between August, 2010 and April, 2012, descending thoracic aorta to femoral artery bypass grafting was used to revascularize lower limbs in 11 patients in our institute. The anesthetic management of these patients is described here. Epidural catheter placement was done in T 5-6 or T 6-7 space for post operative pain relief. Induction was done by, Inj. Glycopyrolate 0.2 mg, Inj. Fentanyl 5 μg/kg., Inj. Pentothal sodium 5 mg/kg, Inj. Rocuronium 0.9 mg/kg, IPPV done. Left sided double lumen tube was inserted, Maintenance of Anesthesia was done by O2 + N2 O (30:70). Increments of Vecuronium and Fentanyl were given Monitoring of Heart rate, arterial pressure, central venous pressure were continuously displayed. The available pharmacological agents were used when there is deviation of more than 15% from base line.
  
  
  RESULTS
  In our study, inspite of measures taken to control rise in blood pressure during aortic cross clamping, a rise of 90 mm of Hg in one patient and 60-80 mm of Hg in four patients was observed, which was managed by sodium nitropruside infusion. At the end of surgery seven patients were extubated on the operation table. In remaining four patients DLT was replaced by single lumen endotracheal tube and were shifted to ICU on IPPV. They weaned off gradually in 3-5 hours. In our series blood loss was 400 ml to 1000 ml. There was no mortality in the first 24 hours. Postoperative bleeding was reported in one case which was re-explored and stood well.
  
  
  CONCLUSIONS
  The anesthetic technique during aortic surgery is directed at minimizing the hemodynamic effects of cross clamping in order to maintain the myocardial oxygen supply demand ratio.
authors.affiliation: Department of Anaesthesiology, SMS Medical College and Associated Group of Hospitals, Jaipur, Rajasthan, India.
authors.forename: Anjum
authors.initials: A
authors.lastname: Saiyed
authors.affiliation: Department of Anaesthesiology, SMS Medical College and Associated Group of Hospitals, Jaipur, Rajasthan, India.
authors.forename: Reema
authors.initials: R
authors.lastname: Meena
authors.affiliation: Department of Anaesthesiology, SMS Medical College and Associated Group of Hospitals, Jaipur, Rajasthan, India.
authors.forename: Indu
authors.initials: I
authors.lastname: Verma
authors.affiliation: Department of Anaesthesiology, SMS Medical College and Associated Group of Hospitals, Jaipur, Rajasthan, India.
authors.forename: C K
authors.initials: CK
authors.lastname: Vyas
keywords: Aortobifemoral bypass; aortoiliac occlusive disease; descending thoracic aorta; juxtarenal occlusion