Anesthesia Management in the Surgical Treatment of Abdominal Aortic Aneurysm
Özet
Abdominal aortic aneurysm (AAA) is a high-risk vascular condition with a significant rupture rate, typically requiring open surgical treatment via laparotomy under general anesthesia when endovascular repair is not indicated. Open AAA surgery presents substantial anesthetic challenges, including prolonged operative time, aortic cross-clamping, severe hemodynamic stress, drop in body temperature, and massive blood loss. Consequently, comprehensive preoperative evaluation is crucial to analyze cardiovascular, pulmonary, and renal risk factors, especially in older male patients. Careful preparation involves organizing necessary blood products, presetting cell-saver autotransfusion devices, and securing multi-lumen central lines. Detailed intraoperative monitoring tracks arterial blood pressure, central venous pressure, urine output, and myocardial ischemia. Anesthesia induction must be highly controlled to avoid extreme blood pressure fluctuations. During cross-clamping, anesthesiologists manage severe proximal hypertension using vasodilators and protect renal function with mannitol. Upon clamp removal, they must aggressively treat declamping shock and metabolic acidosis through volume expansion and vasopressors. In emergency scenarios like ruptured AAA, rapid, event-oriented stabilization and balanced anesthesia induction are critical to maximize patient survival. Finally, postoperative care in the intensive care unit prioritizes continuous hemodynamic monitoring, renal support, and multimodal pain management.
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