Kahn Ronald A, Moskowitz David M, Marin Michael, Hollier Larry
Department of Anesthesiology, Box 1010, Mount Sinai School of Medicine, One East 100th Street, New York, NY 10029, USA.
Mt Sinai J Med. 2002 Jan-Mar;69(1-2):57-67.
Endovascular aortic repair is a new alternative to conventional surgical techniques. A variety of devices available for endovascular aortic repair are discussed and the outcomes after repair are reviewed. Anesthetic considerations during endovascular repair are dictated by the device being used, as well as the site of device deployment. Requirements for the optimization of hemodynamic states during proximal graft deployment are described, as well as the available options for induction of ventricular asystole. Since arterial rupture is always a risk when using this procedure, appropriate facilities must be present for resuscitation. Patients undergoing repair of thoracic aortic pathology may be candidates for perioperative transesophageal echocardiographic monitoring. Since a subgroup of these patients may be at risk for postoperative paraplegia, aggressive spinal cord protection should be considered. Patients with large aneurysms may be at risk for "post-implantation syndrome," which is characterized by hyperpyrexia, hypotension, and coagulopathy.
血管腔内主动脉修复术是传统外科技术的一种新的替代方法。本文讨论了可用于血管腔内主动脉修复术的各种器械，并回顾了修复后的结果。血管腔内修复术中的麻醉考虑因素取决于所使用的器械以及器械植入部位。描述了在近端移植物植入期间优化血流动力学状态的要求，以及诱导心室停搏的可用方法。由于使用该手术时动脉破裂始终是一种风险，因此必须具备适当的复苏设施。接受胸主动脉病变修复的患者可能适合围手术期经食管超声心动图监测。由于这些患者中的一部分可能有术后截瘫的风险，因此应考虑积极的脊髓保护措施。患有大动脉瘤的患者可能有“植入后综合征”的风险，其特征为高热、低血压和凝血病。
