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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