ANESTHETIC MANAGEMENT OF PATIENTS WITH THORACIC AORTIC ANEURYSM

Abstract

Thoracic aortic aneurysm Is still a challenge in the medical and surgical fields as they are associated with considerable morbidity and mortality rates because patients with aortic aneurysms are usually elderly ones have cardiovascular, respiratory, renal, endocrine and metabolic diseases.

Causes of thoracic aortic aneurysms Include, atherosclerosis, cystic medial necrosis, v•asculltis, Infections, congenital and traumatic.

For ascending aortic aneurysms cardiopulmonary by pass Is usually used, beside repair of the aneurysm the aortic valve may be replaced and re-lmplantation of the coronary arteries may be needed.

For aortic arch aneurysms, total circulatory arrest with profound hypothermia is used; beside this retrograde cerebral perfusion (RCP) or antegrade cerebral perfusion (ACP) Is used to provide cerebral protection during arch replacement. Many drugs used for cerebral protection during repair aortic arch beside the surgical procedures for cerebral protection For descending aortic aneurysms aortic cross clamping technique is usually used but cardiopulmonary bypass may be used in certain cases.

One lung anesthesia is usually used by using double­ lumen tube.

Aortic cross clamping causes hemodynamic and metabolic effects both proximal and distal to the clamp, the most serious one Is spinal cord Ischemia which carry the risk of postoperative paraplegia.