5925Icahn School of Medicine at Mount Sinai, New York, USA.
J Perioper Pract. 2021 Jul-Aug;31(7-8):281-288. doi: 10.1177/1750458920936064. Epub 2020 Jul 10.
Thoracic aortic aneurysms present significant challenges to clinicians, especially due to their complex nature and an evolving understanding of the safest and most effective ways to manage this condition in the perioperative setting. Thoracic aortic aneurysms have a prevalence rate of 1.3-8.9% in men and 1.0-2.2% in women, and they are estimated to affect more than five per 100,000 person-years. This is notable because the complications of thoracic aortic aneurysms can be catastrophic. The current understanding of the optimal intraoperative management of thoracic aortic aneurysms is changing, as more evidence becomes available regarding lung protective ventilation and its role in enhancing patient safety and wellbeing. This review strives to provide a brief historical understanding of thoracic aortic aneurysms and highlight some of the key discoveries and advances in the management of this condition. This review then describes an overview of the general anaesthetic principles associated with thoracic aortic aneurysms, including ventilatory modalities and how these impact a patient's physiology and intraoperative haemodynamics. A brief discussion on one-lung ventilation is then provided, drawing from current literature in the field, to describe the most up-to-date management of thoracic aortic aneurysms.
胸主动脉瘤对临床医生来说是一个巨大的挑战，特别是由于其复杂的性质，以及对于围手术期处理这种疾病的最安全和最有效的方法的认识在不断发展。男性胸主动脉瘤的患病率为 1.3-8.9%，女性为 1.0-2.2%，估计每 10 万人中有超过 5 人患病。这一点值得注意，因为胸主动脉瘤的并发症可能是灾难性的。随着关于肺保护性通气及其在增强患者安全和健康方面的作用的更多证据的出现，目前对胸主动脉瘤术中最佳管理的理解正在发生变化。这篇综述试图提供胸主动脉瘤的简要历史理解，并强调在这种情况下管理的一些关键发现和进展。然后，该综述描述了与胸主动脉瘤相关的全身麻醉原则概述，包括通气方式以及这些方式如何影响患者的生理学和术中血液动力学。然后从该领域的当前文献中简要讨论单肺通气，以描述胸主动脉瘤的最新管理。
