Anesthesia Management in Thoracic and Thoracoabdominal Aortic Surgery
Özet
This chapter outlines the anesthesia management for patients undergoing descending thoracic and thoracoabdominal aortic surgery, complex procedures carrying substantial perioperative mortality and morbidity due to profound hemodynamic stress, one-lung ventilation, and critical organ ischemia. A thorough preoperative assessment is essential, focusing on identifying significant cardiovascular and pulmonary comorbidities, such as coronary artery disease and chronic obstructive pulmonary disease, through routine and advanced imaging techniques. Perioperatively, clinical management demands extensive monitoring of arterial pressures, cardiac performance via transesophageal echocardiography, and cerebrospinal fluid pressure. Anesthetic maintenance involves balancing volatile or intravenous agents with vasodilators and beta-blockers to manage proximal hypertension during clamping and avoid declamping shock during removal. Protecting vulnerable organs is paramount; spinal cord ischemia risks are mitigated by minimizing cross-clamp times, initiating moderate hypothermia, performing cerebrospinal fluid drainage, and using evoked potential neuromonitoring. Renal preservation relies on cooling and protective pharmacological agents, while postoperative pain is managed using regional blocks rather than thoracic epidural analgesia. Ultimately, successful patient outcomes depend on careful, multidisciplinary planning to control hemodynamics and protect vital organ systems from ischemic injury.
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