Management of Emergency Aortic Aneurysmectomy
Graft reconstruction for abdominal aortic aneurysm was proposed by Dubost et al.  in 1952. The mortality rate within 30 days of surgery has decreased from 15% mean in the 50s and 60s to 1–6% in the 80s. New insights in surgical techniques and pathogenesis of aortic aneurysm formation, improvement of preoperative screening tests for perioperative myocardial ischemia and infarction, more sophisticated intraoperative approaches to assess hemodynamic function and myocardial ischemic episodes can be the factors responsible for mortality declining. In contrast, in patients with ruptured aortic abdominal aneurysms, depending on the severity of hemodynamic instability at the time of the surgery, 30 day death rates may yet reach 70% nowadays . In elective abdominal aortic reconstruction the stress imposed upon the patient by aortic cross clamping and unclamping always represents difficult problems to be managed by the anesthesiologist. It is important to consider that a high percentage of these patients also present a host of coexisting diseases, being of paramount importance ischemic heart disease. However, in emergency situations such as surgical treatment of ruptured aortic aneurysms, these problems usually seen in an elective surgical situation, become more complex, representing one of the most challenging situations to both the surgeon and the anesthesiologist. Despite all modern technical support, mortality rates in this condition are still at the level of 50% in most centers in the world [3, 4].
KeywordsAortic Aneurysm Aortic Abdominal Aneurysm Abdominal Aortic Aneurysm Hemorrhagic Shock Hypertonic Saline
Unable to display preview. Download preview PDF.
- 3.Roizen MF (1990) Anesthesia for emergency surgery for abdominal aortic reconstruction. In: Roizen MF (ed) Anesthesia for vascular surgery. Churchill Livingstone, New York, pp 311–316Google Scholar
- 4.Cunningham AJ (1994) Anaesthesia for abdominal and major vascular surgery. In: Nimmo WS, Rowbotham DJ, Smith G (eds) Anaesthesia, 2nd ed. Blackwell, Oxford, pp 1042–1076Google Scholar
- 5.Bickell HW, Bruttig SP, Millnamow GA et al (1991) The detrimental effects of intravenous crystalloid after aortotomy in swine. Surgery 10: 529–536Google Scholar
- 9.Thompson JE, Vollman RW, Austin DJ et al (1968) Prevention of hypotensive and renal complications of aortic surgery using balanced salt solution: Thirteen-year experience with 670 cases. Ann Surg 767-778Google Scholar
- 11.Bickell WH, Brutting SP, Millnamow GA et al (1992) Use of hypertonic saline/dextran versus lactated Ringer’s solution as a resuscitation fluid after uncontrolled aortic hemorrhage in anesthetized swine. Ann Emerg Med 331: 1105–1109Google Scholar
- 24.Younes RN, Aun F, Accioly CQ et al (1988) Immediate effects and late outcomes of the treatment of hypovolemic patients with hypertonic saline: A prospective double-blind study in 105 patients. Surg Forum 39: 70–72Google Scholar
- 26.Skillman JJ, Restall DS, Salzman EW (1975) Randomized trial of albumin vs. electrolyte solutions during abdominal aortic operations. Surgery 8: 291–303Google Scholar
- 27.Virgilio RW, Rice CL, Smith DE et al (1979) Crystalloid vs colloid resuscitation: is one better? Surgery 86: 129–139Google Scholar
- 28.Fakhry SM, Messick WJ, Sheldon GF (1996) Metabolic effects of massive transfusion. In: Rossi EC, Simon TL, Moss GS et al (eds) Principles of transfusion medicine, 2nd ed. Williams & Wilkins, Baltimore, pp 615–625Google Scholar
- 31.Hartman GS, Bruefach M (1997) Anesthesia for abdominal aortic reconstruction. In: Reich DL (ed) Anesthesia for cardiac patient, vol 15, Saunders, Philadelphia. Anesthesiology Clinics of North America 139–157Google Scholar
- 38.Szilagri DE, Hagemann JH, Smith RF et al (1978) Spinal cord damage in surgery of the abdominal aorta. Surgery 83: 38–56Google Scholar
- 39.Lambert ME, Baguley P, Charlesworth D (1986) Ruptured abdominal aortic aneurysms. J Cardiovasc Surg 27: 256–261Google Scholar