Casthely P A, Fyman P N, Abrams L M, Griepp R B, Ergin M A
Can Anaesth Soc J. 1985 Jan;32(1):73-8. doi: 10.1007/BF03008543.
Mortality and morbidity during aortic arch aneurysm repair is high despite improvements in surgical technique which attempt to assure brain protection during surgery. We successfully managed 17 patients using deep hypothermia and circulatory arrest. Anaesthesia consisted of pancuronium, fentanyl, plus isoflurane or halothane if needed. Pulmonary artery and arterial catheters were inserted. Surface cooling was performed followed by core cooling on cardiopulmonary bypass, using a heat exchanger. Total circulatory arrest was performed when esophageal temperature reached 12-14 degrees C after previous administration of thiopentone 30 mg X kg-1, methylprednisolone 2 gm, furosemide 40 mg and mannitol 25 gm. At that time the head was packed in ice and surgical correction performed. Mean arrest time was 36.5 +/- 13 minutes at a mean oesophageal temperature of 12.5 +/- 0.75 degrees C. No serious, permanent neurological deficit was found. Tracheostomy was required in five patients of whom two had chronic obstructive pulmonary disease (COPD). Two of these patients died of adult respiratory distress syndrome (ARDS) and renal failure. The reported technique is safe and can be easily used in patients undergoing aortic arch aneurysm repair.
尽管手术技术有所改进，试图在手术过程中确保脑保护，但主动脉弓动脉瘤修复术期间的死亡率和发病率仍然很高。我们使用深低温和循环停止成功治疗了17例患者。麻醉包括泮库溴铵、芬太尼，必要时加用异氟烷或氟烷。插入肺动脉和动脉导管。在体外循环下进行体表降温，然后使用热交换器进行核心降温。在预先给予硫喷妥钠30mg/kg-1、甲基泼尼松龙2g、呋塞米40mg和甘露醇25g后，当食管温度达到12-14摄氏度时进行完全循环停止。此时头部用冰包裹并进行手术矫正。平均停止时间为36.5±13分钟，平均食管温度为12.5±0.75摄氏度。未发现严重的永久性神经功能缺损。5例患者需要气管切开术，其中2例患有慢性阻塞性肺疾病（COPD）。这些患者中有2例死于成人呼吸窘迫综合征（ARDS）和肾衰竭。所报道的技术是安全的，并且可以很容易地应用于接受主动脉弓动脉瘤修复术的患者。
