Knapp J, Bernhard M, Rauch H, Hyhlik-Dürr A, Böckler D, Walther A
Klinik für Anaesthesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
Anaesthesist. 2009 Nov;58(11):1161-82. doi: 10.1007/s00101-009-1630-0.
Aortic aneurysms are frequent in the elderly who often suffer from relevant co-morbidities. In Germany it is estimated that approximately 250,000 patients suffer from an aortic aneurysm. Due to the high risk of cardiac or pulmonary complications operative management poses a challenge to the anesthesiologist. Especially hemodynamic management during aortic cross-clamping requires anesthesiologic know-how and an anticipatory use of vasodilators and catecholamines. Furthermore, the anesthesiologist has to protect renal function. In order to avoid paraplegia due to spinal ischemia cerebrospinal fluid drainage may be necessary in patients with aneurysms of the thoracic aorta. In recent years endovascular repair of aortic aneurysms has been established in addition to conventional open surgery. As a consequence in some patients aortic surgery can be performed under regional or local anesthesia. In special cases thoracic endovascular repair requires a medicinal induction of heart arrest or the reduction of aortic blood flow by overpacing.
主动脉瘤在老年人中很常见，他们常常患有相关的合并症。在德国，据估计约有25万名患者患有主动脉瘤。由于心脏或肺部并发症的高风险，手术治疗对麻醉医生来说是一项挑战。特别是在主动脉交叉钳夹期间的血流动力学管理需要麻醉专业知识以及提前使用血管扩张剂和儿茶酚胺。此外，麻醉医生必须保护肾功能。为了避免因脊髓缺血导致截瘫，对于胸主动脉瘤患者可能需要进行脑脊液引流。近年来，除了传统的开放手术外，主动脉瘤的血管内修复术也已确立。因此，在一些患者中，主动脉手术可以在区域或局部麻醉下进行。在特殊情况下，胸主动脉血管内修复需要药物诱导心脏停搏或通过超速起搏减少主动脉血流。
