Stenseth R, Myhre H O
Department of Anaesthesiology, Trondheim Regional Hospital, Norway.
Acta Chir Scand. 1988 Feb;154(2):147-50.
Aneurysm of the descending thoracic or thoracoabdominal aorta was repaired in 12 cases during simple aortic cross-clamping. The regimen for anaesthesia and general monitoring is presented. It includes thoracic epidural analgesia with intravenous general anaesthesia, use of a double-lumen endotracheal tube, continuous registration of ECG, body temperature, urinary output, systemic and pulmonary arterial pressures and central venous pressure, and intermittent measurement of pulmonary capillary wedge pressure (PCWP), cardiac output, blood gases and haemoglobin. Mannitol (25-40 g) is infused prior to aortic cross-clamping, and infusion of sodium nitroprusside and possibly nitroglycerin is begun just before clamping to control left ventricular afterload and preload. Sodium bicarbonate is given to maintain positive base excess. Before declamping, ventilation is increased by 50% and rapid infusion of blood, plasma and crystalloids is begun in order to raise PCWP by 3-5 mmHg. The clamp is gradually released, and small doses of vasopressor may be required to stabilize the circulation. The operation was uncomplicated in 11 cases, but a patient with ruptured aneurysm died of myocardial infarction.
12例降胸段或胸腹主动脉瘤在单纯主动脉交叉钳闭期间完成修复。文中介绍了麻醉及一般监测方案。该方案包括胸段硬膜外镇痛联合静脉全身麻醉、使用双腔气管导管、持续记录心电图、体温、尿量、体循环和肺动脉压以及中心静脉压，间断测量肺毛细血管楔压（PCWP）、心输出量、血气和血红蛋白。在主动脉交叉钳闭前输注甘露醇（25 - 40 g），在钳闭前即刻开始输注硝普钠，可能还包括硝酸甘油，以控制左心室后负荷和前负荷。给予碳酸氢钠以维持正碱剩余。在松开钳夹前，通气量增加50%，并开始快速输注血液、血浆和晶体液，以使PCWP升高3 - 5 mmHg。逐渐松开钳夹，可能需要小剂量血管升压药来稳定循环。11例手术过程顺利，但1例动脉瘤破裂患者死于心肌梗死。
