Anesthesia Management in the Proximal Aortic Surgery
Özet
This text discusses anesthesia management in the surgical treatment of proximal aortic pathologies, such as aortic aneurysms and acute aortic syndromes like type A aortic dissections. These high-risk conditions require prompt diagnosis and rapid surgical intervention due to high mortality rates associated with complications like cardiac tamponade or organ malperfusion. Preoperative evaluation must focus on assessing risks such as aortic regurgitation, atherosclerosis, and mediastinal mass effects, alongside stabilizing the patient’s blood pressure and heart rate using vasodilators and beta-blockers to prevent further dissection or rupture. Intraoperative management relies heavily on advanced monitoring, including invasive arterial lines, transesophageal echocardiography (TEE) for real-time visualization, and neuromonitoring tools like electroencephalography (EEG) and cerebral oximetry (NIRS) to prevent neurological injuries during deep hypothermic circulatory arrest (DHCA). Both selective antegrade cerebral perfusion (SACP) and retrograde cerebral perfusion (RCP) are utilized in conjunction with DHCA for optimal brain protection. Finally, weaning from cardiopulmonary bypass requires careful hemodynamic stabilization, aggressive treatment of hypothermia-induced coagulopathy using blood products, and a smooth transition to postoperative intensive care. Successful outcomes depend heavily on meticulous coordination between the anesthesiologist, surgeon, and perfusionist throughout the perioperative period.
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