Related Experiment Video
Updated: May 29, 2025
11:13
Porcine Model of Infrarenal Abdominal Aortic Aneurysm
Published on: November 21, 2019
9.3K
Anesthetic Management for Proximal Aortic Repair
Thomas R Powell1,2, Emily B Shah3, Ali Khalifa1,2
1Division of Cardiovascular Anesthesiology, Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.
Seminars in Cardiothoracic and Vascular Anesthesia
|February 1, 2025
Summary
Anesthetic management for proximal aortic repair, often requiring cardiopulmonary bypass and hypothermic circulatory arrest, presents unique challenges. This review focuses on evidence-based strategies for cerebral and end-organ protection during these complex procedures.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Thoracic Surgery
Background:
- Proximal aortic repair is a complex surgical procedure.
- It frequently necessitates cardiopulmonary bypass (CPB) and hypothermic circulatory arrest (HCA).
- Cerebral and end-organ protection are critical during circulatory arrest.
Purpose of the Study:
- To provide an evidence-based review of anesthetic management for proximal aortic repair.
- To highlight current best practices for patient protection during CPB and HCA.
- To update clinicians on the latest anesthetic strategies for this high-risk surgery.
Main Methods:
- Comprehensive literature search of peer-reviewed studies.
- Evidence-based synthesis of anesthetic techniques and protective strategies.
- Review of guidelines and expert consensus on proximal aortic repair management.
Main Results:
- Detailed discussion of anesthetic considerations for CPB and HCA.
- Emphasis on neuroprotective and organ-protective measures.
- Integration of multimodal anesthetic approaches for optimal outcomes.
Conclusions:
- Optimal anesthetic management is crucial for successful proximal aortic repair.
- Proactive cerebral and end-organ protection strategies are essential.
- This review provides a foundation for evidence-based anesthetic care in these patients.
Keywords:
brain injurycardiac anesthesiacardiopulmonary bypasscirculatory arrestdeep hypothermic circulatory arresthypothermia for brain protectionintraoperative transesophageal echocardiographynear-infrared spectroscopyneurological monitoringneuroprotectionMore Related Videos
Related Concept Videos
01:24Parenteral Anesthetics: Overview
93
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
93
01:24General Anesthesia: Overview
188
Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
188
01:11Local Anesthetics: Clinical Application as Spinal Anesthesia
572
Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
572
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
352
Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
One of the advantages of...
352
01:13Local Anesthetics: Pharmacokinetics
726
The potency and duration of action of local anesthetics (LAs) are determined by their pharmacokinetics. Pharmacokinetics describes how LAs are absorbed, distributed, metabolized, and eliminated from the body. When administered to the vascular tissues, LAs are quickly absorbed and enter the systemic circulation, reducing their localized effects. Adding vasoconstrictors such as epinephrine to LAs reduces their absorption into the systemic circulation, making them clinically effective. The...
726
01:30Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia
933
Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...
933