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Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

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Anaesthesia for vascular emergencies.

L Ellard¹, G Djaiani

¹Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.

|December 6, 2012

Summary

Managing vascular emergencies requires careful anesthetic considerations. Permissive hypotension and tailored anesthesia choices can improve outcomes for patients with acute aortic syndrome and limb ischemia.

Area of Science:

Anesthesiology
Vascular Surgery
Emergency Medicine

Background:

Patients with vascular emergencies face high peri-operative risks.
Endovascular surgery offers potential mortality benefits, pending trial results.

Purpose of the Study:

To discuss anesthetic management for vascular emergencies.
To highlight the impact of endovascular repair on anesthesia.

Main Methods:

Review of anesthetic considerations for acute aortic syndrome, ruptured aneurysms, trauma, and limb ischemia.
Discussion of permissive hypotension, anesthesia types, and cerebrospinal fluid drainage.

Main Results:

Permissive hypotension (SBP 50-100 mmHg) is recommended pre-operatively.

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Anesthesia type (local vs. general) should be individualized.

Cerebrospinal fluid drainage is generally impractical emergently but considered postoperatively.

Conclusions:

Anesthetic management must be tailored to the specific vascular emergency and patient.
Endovascular repair influences anesthetic strategies.
Further evidence from randomized trials is needed for definitive conclusions on endovascular repair and anesthesia choices.