ANESTHESIA FOR SURGERY ON THE AORTA
Surgery on the aorta represents one of
the great-est challenges for anesthesiologists. Regardless of which part of the
vessel is involved, the procedure is complicated by the need to cross-clamp the
aorta and by the potential for large intraoperative blood losses. Aortic
cross-clamping without CPB acutely increases left ventricular afterload and
severely com-promises organ perfusion distal to the point of occlu-sion. Severe
hypertension, myocardial ischemia, left ventricular failure, or aortic valve
regurgitation may be precipitated. Interruption of blood flow to the spinal
cord, kidneys, and intestines can produce paraplegia, kidney failure, or
intestinal infarction, respectively. Moreover, emergency aortic surgery is
frequently necessary in critically ill patients who are acutely hypovolemic and
have a high incidence of coexistent cardiac, renal, and pulmonary disease;
hypertension; and diabetes.Indications for aortic surgery include aortic
dissections, aneurysms, occlusive disease, trauma, and coarctation. Lesions of
the ascending aorta lie between the aortic valve and the innominate artery,
whereas lesions of the aortic arch lie between the innominate and left
subclavian arteries. Disease distal to the left subclavian artery but above the
diaphragm involves the descending thoracic aorta; lesions below the diaphragm
involve the abdominal aorta.
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