Volume 69 Numbers 1 & 2 January/March 2002	back to contents

Anesthetic Considerations for Endovascular Aortic Repair	57-67
Ronald A. Kahn, M.D.1, David M. Moskowitz, M.D.2, Michael Marin, M.D.3,4, and Larry Hollier, M.D.3,5

¹Assistant Professor of Anesthesiology, Department of Anesthesiology, ³Professor of Surgery, ⁴Henry Kaufman Professor of Vascular Surgery, and Chief of Vascular Surgery, and ⁵Julius H. Jacobson II M.D. Professor of Vascular Surgery, and Chairman, The Ruth and Maxwell Hauser and Harriet and Arthur H Aufses, Jr., M.D. Department of Surgery, Mount Sinai School of Medicine, New York, NY; and ²Attending, Department of Anesthesiology, Englewood Hospital and Medical Center, Englewood, NJ.

Address correspondence to Ronald A. Kahn, M.D., Department of Anesthesiology, Box 1010, Mount Sinai School of Medicine, One East 100th Street, New York, NY 10029.

ABSTRACT

Endovascular aortic repair is a new alternative to conventional surgical techniques. A variety of devices available for endovascular aortic repair are discussed and the outcomes after repair are reviewed. Anesthetic considerations during endovascular repair are dictated by the device being used, as well as the site of device deployment. Requirements for the optimization of hemodynamic states during proximal graft deployment are described, as well as the available options for induction of ventricular asystole. Since arterial rupture is always a risk when using this procedure, appropriate facilities must be present for resuscitation. Patients undergoing repair of thoracic aortic pathology may be candidates for perioperative transesophageal echocardiographic monitoring. Since a subgroup of these patients may be at risk for postoperative paraplegia, aggressive spinal cord protection should be considered. Patients with large aneurysms may be at risk for “post-implantation syndrome,” which is characterized by hyperpyrexia, hypotension, and coagulopathy.

KEYWORDS

Endovascular surgery, anesthesia, aortic aneurysms, aortic repair, transesophageal echocardiography, adenosine, cardiac asystole, ventricular fibrillation, paraplegia.

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