Seminars in Cardiothoracic and Vascular Anesthesia

 

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Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 11, No. 3, 205-223 (2007)
DOI: 10.1177/1089253207306098
© 2007 SAGE Publications and the British Sociological Association

Anesthetic Consideration for Descending Thoracic Aortic Aneurysm Repair

Ronald A. Kahn, MD

Department of Anesthesiology, the Mount Sinai School of Medicine, New York, New York, ron.kahn{at}mssm.edu

Marc E. Stone, MD

Department of Anesthesiology, the Mount Sinai School of Medicine, New York, New York

David M. Moskowitz, MD

Department of Anesthesiology, Englewood Medical Center, Engelwood, NJ

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.

Key Words: aorta • thoracic thoracoabdominal aneurysms • surgery • anesthetic management • cerebral spinal fluid drainage • partial cardiopulmonary bypass


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