Department of Anesthesia, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Anaesthesia. 2013 Jan;68 Suppl 1:72-83. doi: 10.1111/anae.12048.
Patients presenting with vascular emergencies including acute aortic syndrome, ruptured thoracic or abdominal aortic aneurysms, thoracic aortic trauma and acute lower limb ischaemia have a high risk of peri-operative morbidity and mortality. Although anatomical suitability is not universal, endovascular surgery may improve mortality and the results of ongoing randomised controlled trials are awaited. Permissive hypotension pre-operatively should be the standard of care with the systolic blood pressure kept to 50-100 mmHg as long as consciousness is maintained. The benefit of local anaesthesia over general anaesthesia is not definitive and this decision should be tailored for a given patient and circumstance. Cerebrospinal fluid drainage for prevention of paraplegia is often impractical in the emergency setting and is not backed by strong evidence; however, it should be considered postoperatively if symptoms develop. We discuss the pertinent anaesthetic issues when a patient presents with a vascular emergency and the impact that endovascular repair has on anaesthetic management.
就诊的血管急症患者包括急性主动脉综合征、胸或腹主动脉夹层破裂、胸主动脉创伤和急性下肢缺血，具有围手术期高发病率和死亡率的风险。尽管解剖学适合性并非普遍存在，但血管内手术可能会降低死亡率，正在进行的随机对照试验的结果正在等待中。术前允许性低血压应成为标准治疗方法，只要意识保持清醒，收缩压应保持在 50-100mmHg。局部麻醉优于全身麻醉的益处并不明确，并且应根据特定患者和情况来定制这一决策。在紧急情况下，预防截瘫的脑脊液引流通常不切实际，也没有强有力的证据支持；然而，如果出现症状，术后应考虑进行引流。当患者出现血管急症时，我们将讨论相关的麻醉问题，以及血管内修复对麻醉管理的影响。
