Anesthesia for aortic operations
Alexander Romagnoli, M.D.
John R. Cooper, M.D.
The aorta is the largest, single most important artery through which all blood flows at high velocity and pressure to all parts of the body. This vessel is often affected by aneurysmal dilatation of varying etiology and severity, as well as coarctations, all of which need surgical correction. Aneurysms if untreated will eventually rupture and cause sudden death. Coarctations put a severe strain on the left ventricle, causing failure and also distal hypoperfusion.
Surgical excision and grafting is the therapy of choice in the treatment of aortic aneurysms and may often be performed under emergency conditions when dissection or rupture is in progress.
Preparation for anesthesia begins with the preoperative visit which includes an evaluation of the lesion to ascertain surgical requirements (Table 1) and also includes an assessment of concurrent conditions, which are often serious and may greatly affect the recovery of the patient (Table 2). Preoperative sedation can be accomplished with diazepam (Valium), meperidine (Demerol), and scopolamine, but is largely a matter of individual preference. However, one must consider the advanced age of many of these patients, and avoid respiratory or circulatory depression (Table 3).
Induction of anesthesia should be smooth; pentothal, diazepam, narcotics, nitrous oxide and adequate muscle relaxants are the agents of choice. Ethrane or halothane may be added if indicated. Great care must be taken in obtunding the sympathetic reflexes during intubation to avoid sudden and excessive rise in heart rate and blood pressure. Arrhythmias, as well as sudden dissection or rupture of the aneurysm . . .