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General Anesthesia: Overview

General Anesthesia: Overview

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...

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Anesthetic Perspective on Total Arch Replacement With Frozen Elephant Trunk Surgery.

Myungsoo Jang¹, Sang Beom Nam¹, Youn Jin Kim¹

¹Department of Anesthesia and Pain Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea.

Journal of Cardiothoracic and Vascular Anesthesia

|December 5, 2025

Summary

Total arch replacement with frozen elephant trunk (TARFET) is a complex procedure for aortic disease. Anesthesiologists play a critical role in patient preparation, monitoring, and ensuring procedural success for improved outcomes.

Keywords:

anesthesiologists cerebral protection extensive aortic pathologies spinal cord protection total arch replacement with frozen elephant trunk transesophageal echocardiography

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Area of Science:

Cardiovascular Surgery
Anesthesiology
Thoracic Surgery

Background:

Extensive aortic pathologies require advanced surgical techniques.
Total arch replacement with frozen elephant trunk (TARFET) is a leading treatment for these conditions.
TARFET surgery presents significant anesthetic and surgical challenges.

Purpose of the Study:

To review key perioperative anesthetic considerations for TARFET surgery.
To highlight the anesthesiologist's role in neuroprotection and hemodynamic management.
To emphasize the importance of intraoperative transesophageal echocardiography in TARFET procedures.

Main Methods:

This narrative review synthesizes current knowledge on anesthetic management for TARFET.
Focuses on strategies for cerebral and spinal cord protection.
Discusses the utility of intraoperative transesophageal echocardiography.

Main Results:

Anesthesiologists are crucial for preoperative assessment, intraoperative monitoring, and hemodynamic support.
Neurologic monitoring and targeted protection strategies are vital for preventing complications.
Transesophageal echocardiography aids in evaluating stent graft placement and perfusion.

Conclusions:

Successful TARFET surgery relies on a multidisciplinary heart team approach.
Vigilant intraoperative monitoring and effective anesthetic management are essential for optimal patient outcomes.
Anesthesiologists' expertise is indispensable in managing the complexities of TARFET procedures.